The cost-effectiveness of different approaches to exercise and corticosteroid injection for subacromial pain (impingement) syndrome

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Objectives

To determine whether physiotherapist-led exercise intervention and ultrasound-guided subacromial corticosteroid injection is cost-effective when compared with standard advice and exercise leaflet and unguided injection in patients with subacromial pain (impingement) syndrome.

Methods

An incremental cost–utility analysis using patient responses to the five-level EuroQoL-5D (EQ-5D-5L) questionnaire was undertaken from a health care perspective alongside a 2x2 factorial randomised trial with 256 participants over a 12-month follow-up period. Uncertainty was explored through the use of cost-effectiveness acceptability curves.

Results

The cost–utility analysis indicated that physiotherapist-led exercise was associated with an incremental cost of £155.99 (95% CI: 69.02–241.93) and 0.031 (95% CI: −0.01–0.07) additional quality-adjusted life-years (QALYs), an incremental cost-effectiveness ratio (ICER) of £5,031 per QALY gained and an 85% chance of being cost-effective at a threshold of £20 000 per QALY gained compared with the advice and exercise leaflet. Ultrasound-guided injection was associated with an incremental cost of £15.89 (95% CI: −59.36–109.86) and 0.024 (95% CI: −0.02–0.07) additional QALYs, an ICER of £662 per QALY gained and a 83% chance of being cost-effective at a threshold of £20 000 per QALY gained compared with unguided injection.

Conclusion

Physiotherapist-led exercise was cost-effective compared with the advice and exercise leaflet, and ultrasound-guided injection was cost-effective when compared with unguided injection.



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