James M, Stokes E A, Thomas E, Dziedzic K, Hay E M
Centre for Health Planning and Management, Keele University, Keele, Staffordshire ST5 5BG, UK.
Rheumatology (Oxford). 2005 Nov;44(11):1447-51. doi: 10.1093/rheumatology/kei043. Epub 2005 Aug 9.
Local steroid injections and community-based physiotherapy have been shown to be of similar benefit for treating shoulder pain presenting to primary care. This paper presents a cost consequences analysis of a prospective economic evaluation, conducted alongside a randomized clinical trial (RCT) of corticosteroid injections versus physiotherapy for new episodes of unilateral shoulder pain, to determine the economic implications of injection versus physiotherapy.
A pragmatic RCT with 207 patients randomized to either physiotherapy (n = 103) or local steroid injection (n = 104) was conducted. The resource inputs required were identified for each treatment arm in terms of capital, staff and consumables. These were measured for the period up to 6 months post-randomization. Outcome measures included shoulder disability, shoulder pain, global assessment of health change and the EQ5D, all at 6 months. A sensitivity analysis was performed around the general practitioner minor surgical fee.
Analysis is presented on the 199 patients for which the general practice record review (101 physiotherapy, 98 injection) was available. The total mean costs, per patient, were 71.28 pound sterling for the injection group and 114.60 pound sterling for the physiotherapy group. The difference in average total cost per patient was 43.32 pound sterling (95% bootstrap confidence interval: 16.21 pound sterling, 68.03 pound sterling ). This is a statistically significant difference in cost. Outcome was similar in both groups across all measures following intervention. Smaller mean differences in cost were observed between the treatment groups in the sensitivity analysis, but the difference remained in favour of injection over physiotherapy.
This study has shown, given similar clinical outcomes across the treatment groups, that corticosteroid injections were the cost-effective option for patients presenting with new episodes of unilateral shoulder pain in primary care.
局部类固醇注射和基于社区的物理治疗已被证明在治疗基层医疗中出现的肩部疼痛方面具有相似的益处。本文介绍了一项前瞻性经济评估的成本后果分析，该评估与一项关于皮质类固醇注射与物理治疗对单侧肩部疼痛新发作的随机临床试验（RCT）同时进行，以确定注射与物理治疗的经济影响。
进行了一项实用的RCT，将207名患者随机分为物理治疗组（n = 103）或局部类固醇注射组（n = 104）。确定了每个治疗组在资本、人员和消耗品方面所需的资源投入。在随机分组后的6个月内对这些进行了测量。结局指标包括肩部残疾、肩部疼痛、健康变化的总体评估以及EQ5D，均在6个月时进行测量。围绕全科医生小手术费用进行了敏感性分析。
对199名可获得全科医疗记录审查结果的患者（101名接受物理治疗，98名接受注射）进行了分析。注射组每位患者的总平均成本为71.28英镑，物理治疗组为114.60英镑。每位患者平均总成本的差异为43.32英镑（95%自举置信区间：16.21英镑，68.03英镑）。这是成本方面具有统计学意义的差异。干预后两组在所有测量指标上的结局相似。在敏感性分析中，治疗组之间观察到的成本平均差异较小，但差异仍然有利于注射而非物理治疗。
本研究表明，鉴于各治疗组的临床结局相似，皮质类固醇注射是基层医疗中出现单侧肩部疼痛新发作患者的成本效益选择。
