Woods Beth, Manca Andrea, Weatherly Helen, Saramago Pedro, Sideris Eleftherios, Giannopoulou Christina, Rice Stephen, Corbett Mark, Vickers Andrew, Bowes Matthew, MacPherson Hugh, Sculpher Mark
Centre for Health Economics, University of York, York, United Kingdom.
Centre for Reviews and Dissemination, University of York, York, United Kingdom.
PLoS One. 2017 Mar 7;12(3):e0172749. doi: 10.1371/journal.pone.0172749. eCollection 2017.
There is limited information on the costs and benefits of alternative adjunct non-pharmacological treatments for knee osteoarthritis and little guidance on which should be prioritised for commissioning within the NHS. This study estimates the costs and benefits of acupuncture, braces, heat treatment, insoles, interferential therapy, laser/light therapy, manual therapy, neuromuscular electrical stimulation, pulsed electrical stimulation, pulsed electromagnetic fields, static magnets and transcutaneous electrical nerve Stimulation (TENS), based on all relevant data, to facilitate a more complete assessment of value.
Data from 88 randomised controlled trials including 7,507 patients were obtained from a systematic review. The studies reported a wide range of outcomes. These were converted into EQ-5D index values using prediction models, and synthesised using network meta-analysis. Analyses were conducted including firstly all trials and secondly only trials with low risk of selection bias. Resource use was estimated from trials, expert opinion and the literature. A decision analytic model synthesised all evidence to assess interventions over a typical treatment period (constant benefit over eight weeks or linear increase in effect over weeks zero to eight and dissipation over weeks eight to 16).
When all trials are considered, TENS is cost-effective at thresholds of £20-30,000 per QALY with an incremental cost-effectiveness ratio of £2,690 per QALY vs. usual care. When trials with a low risk of selection bias are considered, acupuncture is cost-effective with an incremental cost-effectiveness ratio of £13,502 per QALY vs. TENS. The results of the analysis were sensitive to varying the intensity, with which interventions were delivered, and the magnitude and duration of intervention effects on EQ-5D.
Using the £20,000 per QALY NICE threshold results in TENS being cost-effective if all trials are considered. If only higher quality trials are considered, acupuncture is cost-effective at this threshold, and thresholds down to £14,000 per QALY.
关于膝骨关节炎替代辅助非药物治疗的成本和效益的信息有限，对于在英国国家医疗服务体系（NHS）内委托开展哪些治疗应优先考虑，几乎没有指导意见。本研究基于所有相关数据，估计了针灸、支具、热疗、鞋垫、干扰电疗法、激光/光疗法、手法治疗、神经肌肉电刺激、脉冲电刺激、脉冲电磁场、静磁体和经皮神经电刺激（TENS）的成本和效益，以促进对价值进行更全面的评估。
从一项系统评价中获取了88项随机对照试验的数据，包括7507名患者。这些研究报告了广泛的结果。使用预测模型将这些结果转换为EQ-5D指数值，并使用网络荟萃分析进行综合。分析首先包括所有试验，其次仅包括选择偏倚风险低的试验。资源使用从试验、专家意见和文献中进行估计。一个决策分析模型综合了所有证据，以评估在一个典型治疗期内的干预措施（在八周内效益恒定，或在第零周至第八周效果呈线性增加，在第八周至第十六周逐渐消失）。
当考虑所有试验时，TENS在每QALY 20000 - 30000英镑的阈值下具有成本效益，与常规护理相比，增量成本效益比为每QALY 2690英镑。当考虑选择偏倚风险低的试验时，针灸具有成本效益，与TENS相比，增量成本效益比为每QALY 13502英镑。分析结果对干预措施实施的强度、干预对EQ-5D的影响程度和持续时间的变化敏感。
如果考虑所有试验，使用每QALY 20000英镑的英国国家卫生与临床优化研究所（NICE）阈值会使TENS具有成本效益。如果仅考虑质量较高的试验，在该阈值以及低至每QALY 14000英镑的阈值下，针灸具有成本效益。
