在髋关节骨关节炎的建议和教育基础上增加超声引导下皮质类固醇和局部麻醉剂注射的成本效益。

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

作者信息

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

机构信息

Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.

School of Medicine, Keele University, Keele, UK.

出版信息

Rheumatology (Oxford). 2025 Jan 1;64(1):165-172. doi: 10.1093/rheumatology/kead659.

DOI:10.1093/rheumatology/kead659

PMID:38085178

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11701301/

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, with BCT plus a single ultrasound-guided intra-articular hip injection of 40 mg triamcinolone acetonide and 4 ml 1% lidocaine hydrochloride (BCT+US-T).

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 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, £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 (8 August 2015) and registered with Current Controlled Trials: ISRCTN 50550256 (28 July 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, doi: doi.org/10.1186/s12891-018-2153-0.

摘要

目的

髋关节骨关节炎（OA）患者关节内注射皮质类固醇的相对成本效益证据仍不明确。本研究调查了当前最佳治疗（BCT，包括建议和教育）联合40毫克曲安奈德和4毫升1%盐酸利多卡因单次超声引导下髋关节内注射（BCT+US-T）的成本效益。

方法

对BCT+US-T与BCT进行了为期6个月的基于试验的成本效用分析。获取了患者层面的成本数据，并以质量调整生命年（QALYs）衡量有效性，从而从英国国家医疗服务体系（NHS）的角度计算每获得一个QALY的成本。

结果

BCT+US-T与较低的平均NHS成本相关（BCT+US-T减去BCT：-161.6英镑；95%置信区间：-583.95英镑，54.18英镑），且在6个月内平均QALYs略高于单独使用BCT（BCT+US-T减去BCT：0.0487；95%置信区间：0.0091，0.0886）。在基础案例中，BCT+US-T是最具成本效益的，且优于单独使用BCT。总成本的差异由就诊NHS顾问、私人物理治疗师和脊椎按摩师的次数以及髋关节手术驱动，单独使用BCT比BCT+US-T更常见这些情况。