The cost-effectiveness of adding an ultrasound corticosteroid and local anaesthetic injection to advice and education for hip osteoarthritis

Jesse Kigozi; Raymond Oppong; Zoe Paskins; Kieran Bromley; Martyn Lewis; Gemma Hughes; Emily Hughes; Susie Hennings; Andrea Cherrington; Alison Hall; Melanie A Holden; Kay Stevenson; Ajit Menon; Philip Roberts; George Peat; Clare Jinks; Nadine E Foster; Christian D Mallen; Edward Roddy

doi:10.1093/rheumatology/kead659

The cost-effectiveness of adding an ultrasound corticosteroid and local anaesthetic injection to advice and education for hip osteoarthritis

Rheumatology (Oxford). 2023 Dec 12:kead659. doi: 10.1093/rheumatology/kead659. Online ahead of print.

Authors

Jesse Kigozi¹, Raymond Oppong¹, Zoe Paskins^{2

3}, Kieran Bromley⁴, Martyn Lewis⁴, Gemma Hughes⁴, Emily Hughes⁴, Susie Hennings⁴, Andrea Cherrington⁴, Alison Hall², Melanie A Holden², Kay Stevenson³, Ajit Menon³, Philip Roberts⁵, George Peat^{2

6}, Clare Jinks², Nadine E Foster^{2

7}, Christian D Mallen^{2

3}, Edward Roddy^{2

3}

Affiliations

¹ Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
² School of Medicine, Keele University, Keele, UK.
³ Haywood Academic Rheumatology Centre, Midlands Partnership University NHS Foundation Trust, Stoke-on-Trent, UK.
⁴ Keele Clinical Trials Unit, Keele University, Keele, UK.
⁵ University Hospitals North Midlands, Stoke-on-Trent, UK.
⁶ Centre for Applied Health & Social Care Research (CARe), Sheffield Hallam University, Sheffield, UK.
⁷ Surgical Treatment And Rehabilitation Service (STARS), Research and Education Alliance, The University of Queensland and Metro North Health, Brisbane, QLD, Australia.

PMID: 38085178
DOI: 10.1093/rheumatology/kead659

Abstract

Objectives: Evidence for the comparative cost-effectiveness of intra-articular corticosteroid injection in people with hip osteoarthritis (OA) remains unclear. This study investigated the cost-effectiveness of best current treatment (BCT) comprising advice and education plus a single ultrasound-guided intra-articular hip injection (USGI) of 40 mg triamcinolone acetonide and 4 ml 1% lidocaine hydrochloride (BCT+US-T) versus BCT alone.

Methods: A trial-based cost-utility analysis of BCT+US-T compared with BCT was undertaken over 6 months. Patient-level cost data were obtained, and effectiveness was measured in terms of quality-adjusted life years (QALYs), allowing the calculation of cost per QALY gained from a United Kingdom (UK) National Health Service (NHS) perspective.

Results: BCT+US-T was associated with lower mean NHS costs (BCT+US-T minus BCT: £-161.6, 95% CI: £-583.95 to £54.18) and small but significantly higher mean QALYs than BCT alone over 6 months (BCT+US-T minus BCT: 0.0487, 95% CI: 0.0091, 0.0886). In the base case, BCT+US-T was the most cost-effective and dominated BCT alone. Differences in total costs were driven by number of visits to NHS consultants, private physiotherapists, and chiropractors, and hip surgery, which were more common with BCT alone than BCT+US-T.

Conclusion: Intra-articular corticosteroid injection plus BCT (BCT+US-T) for patients with hip OA results in lower costs and better outcomes, and is highly cost-effective, compared with BCT alone.

Trial registration: EudraCT: 2014-003412-37 (August 8, 2015) and registered with Current Controlled Trials: ISRCTN 50550256 (July 28, 2015).

Trial protocol: Full details of the trial protocol can be found in the Supplementary Appendix, available with the full text of this article at https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-018-2153-0#citeas.

Doi: doi.org/10.1186/s12891-018-2153-0.

Keywords: corticosteroid injection; cost-effectiveness; cost-utility; economic evaluation; hip osteoarthritis.