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Cost-effectiveness of joint protection and hand exercise for hand osteoarthritis

Oppong, R; Jowett, S; Nicholls, E; Hill, S; Hammond, A; Hay, E; Dziedzic, K


R Oppong

S Jowett

E Nicholls

S Hill

E Hay

K Dziedzic


Background: European guidelines have proposed that joint protection and hand exercise should be used in the management of hand osteoarthritis (OA). However, the evidence regarding the cost-effectiveness of these interventions has not been well established. A 2x2 factorial trial was carried out to compare the effectiveness and cost-effectiveness of joint protection (JP) and/or hand exercise (HE) compared with leaflet and advice (LA). The trial demonstrated JP was the most effective management option as indicated by the primary outcome measure (OARSI/OMERACT responder criteria), over a 6 month period. However, there is no consensus about the most appropriate method for conducting an economic evaluation alongside a factorial trial. The aim of this study is to assess the cost-effectiveness of management options for hand OA and to compare different methods for conducting an economic evaluation alongside a factorial trial.
Methods: A cost-utility analysis was undertaken over a 12 month period. Patient level resource use and EQ-5D data were obtained from postal questionnaires, and mean costs and quality-adjusted life years (QALYs) were calculated for each trial arm. Incremental cost-effectiveness ratios (ICERs) were estimated and cost-effectiveness acceptability curves constructed. The base case analysis used a within the table analysis methodology, comparing JP alone, HE alone, JP plus HE and LA. Two further methods were used: the at the margins approach, and a regression approach with or without an interaction term.
Results: 257 patients were randomised to receive one of the interventions. Mean costs (SD) recorded in each treatment arm were £50.24 (265.40), £104.40 (93.28), £82.29 (108.22) and £57.21 (76.88) for LA, JP+HE, JP and HE respectively. Mean QALYs (SD) associated with each trial arm were 0.662 (0.166), 0.681 (0.135), 0.659 (0.157) and 0.658 (0.164) respectively. In the base case analysis, hand exercise was the most cost effective option with an ICER of £367 per QALY gained compared with leaflet and advice, and with an 80% chance of being cost-effective at a threshold of £30,000 per QALY gained. With the alternative analysis methods, hand exercise remained the most cost-effective management strategy, with ICERs consistently less than £2000 per QALY gained and a probability of being cost-effective at least 70%.
Conclusions: This study has provided cost-effectiveness estimates for management options for hand OA. The results of this study showed that hand exercise was the most cost-effective option irrespective of the method of analysis adopted. However, the clinical findings indicated that joint protection was the most effective option. Possible reasons for this disparity include the use of different outcome measures (responder criteria versus QALYs), reduced statistical power and lack of sensitivity of the EQ-5D questionnaire.


Oppong, R., Jowett, S., Nicholls, E., Hill, S., Hammond, A., Hay, E., & Dziedzic, K. (2013). Cost-effectiveness of joint protection and hand exercise for hand osteoarthritis. Rheumatology,

Journal Article Type Article
Publication Date 2013
Deposit Date Oct 23, 2023
Journal Rheumatology
Print ISSN 1462-0324
Publisher Oxford University Press
Peer Reviewed Peer Reviewed