Cost-effectiveness of a model consultation to support self-management in patients with osteoarthritis

Abstract

ObjectivesThe aim of this study was to estimate the cost-effectiveness of a model OA consultation for OA to support self-management compared with usual care. MethodsAn incremental cost–utility analysis using patient responses to the three-level EuroQoL-5D (EQ-5D) questionnaire was undertaken from a UK National Health Service perspective alongside a two-arm cluster-randomized controlled trial. Uncertainty was explored through the use of cost-effectiveness acceptability curves.ResultsDifferences in health outcomes between the model OA consultation and usual care arms were not statistically significant. On average, visits to the orthopaedic surgeon were lower in the model OA consultation arm by −0.28 (95% CI: −0.55, −0.06). The cost–utility analysis indicated that the model OA consultation was associated with a non-significant incremental cost of £−13.11 (95% CI: −81.09 to 54.85) and an incremental quality adjusted life year (QALY) of −0.003 (95% CI: −0.03 to 0.02), with a 44% chance of being cost-effective at a threshold of £20 000 per QALY gained. The percentage of participants who took time off and the associated productivity cost were lower in the model OA consultation arm.ConclusionImplementing National Institute for Health and Care Excellence guidelines using a model OA consultation in primary care does not appear to lead to increased costs, but health outcomes remain very similar to usual care. Even though the intervention seems to reduce the demand for orthopaedic surgery, overall it is unlikely to be cost-effective.

A Systematic Review of the Feasibility and Psychometric Properties of the ICEpop CAPability Measure for Adults and Its Use So Far in Economic Evaluation

“…28 Evaluation of a model consultation for osteoarthritis patients suggested better outcomes in the usual care arm, but showed an insignificant difference in health gains between treatment arms with both the EQ-5D-3L and SF-6D; similar results were observed when outcomes were assessed using the ICECAP-A. 23 Similarly, using both health (EQ-5D-5L) and capability (ICECAP-A) as evaluative spaces within a costconsequence analysis of digital against traditional foot orthoses in patients with diabetes revealed no statistically significant differences between arms. 24 When ICECAP-A was used in the sensitivity analysis of a cost-utility study exploring the cost-effectiveness of an electronic vision enhancement system-in which the vision-related quality-of-life instrument was used as the primary outcome-the intervention was no longer considered cost-effective (a result also observed when switching to the EQ-5D-5L).…”

“…Most of the studies were conducted in the United Kingdom [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] ; 1 was conducted in Canada, 35 and 1 across both Australia and the United Kingdom. 36 Seven studies were considered multi-country, because they involved participants from several of the following countries: Australia, Canada, Germany, Norway, the United States, and the United Kingdom.…”

“…Three studies used the instrument among osteoarthritis patients, with 2 assessing construct validity and responsiveness 18,19 and 1 assessing the cost-effectiveness of a model consultation for self-management in osteoarthritis patients. 23 The area of drug addiction and opiate dependence was investigated by Goranitis et al 21,22 Other populations were women with lower urinary tract symptoms, 17 people with visual impairment, 20,27 patients with diabetes, 24 Huntington disease patients, 26 people with spinal cord injury, 35 and patients with cancer (oral/oropharyngeal and gynecological). 28,29 Some studies involved carers, 1 evaluating the family impact of meningitis 32 and 1 exploring the quality of life among people receiving hospice care.…”

Optimal primary care management of clinical osteoarthritis and joint pain in older people: a mixed-methods programme of systematic reviews, observational and qualitative studies, and randomised controlled trials

“…Parts of this section have been amended and reproduced from Oppong et al 172 © The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Rheumatology.…”

Exercise Experience of Elderly Medicaid Beneficiaries with Osteoarthritis Based on Self-Determination Theory

“…3) Hence, osteoarthritis is widely known as a disease that requires self-management. 4) Although self-care for general physical activity and exercise plays an important role, not many patients continue exercise. 5) Among the exercise and physical activities, walking not only motivates the adaptation of an active lifestyle but it is also an easily acceptable and effective symptom relief in the community base.…”