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Economic costs, health-related quality of life outcomes and cost-utility of a physical and psychological group intervention targeted at older adults with neurogenic claudication
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Mandy, Maredza, Kamran, Khan, Marian, Ioana R., Dutton, Susan J., Esther, Williamson, Lamb, Sarah E. and Stavros, Petrou (2023) Economic costs, health-related quality of life outcomes and cost-utility of a physical and psychological group intervention targeted at older adults with neurogenic claudication. Cost effectiveness and resource allocation, 21 (1). 14. doi:10.1186/s12962-022-00410-y ISSN 1478-7547.
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Official URL: https://doi.org/10.1186/s12962-022-00410-y
Abstract
Background: Emerging evidence suggests that structured and progressive exercise underpinned by a cognitive behavioural approach can improve functional outcomes in patients with neurogenic claudication (NC). However, evidence surrounding its economic benefits is lacking. Objectives: To estimate the economic costs, health-related quality of life outcomes and cost-effectiveness of a physical and psychological group intervention (BOOST programme) versus best practice advice (BPA) in older adults with NC. Methods: An economic evaluation was conducted based on data from a pragmatic, multicentre, superiority, randomised controlled trial. The base-case economic evaluation took the form of an intention-to-treat analysis conducted from a UK National Health Service (NHS) and personal social services (PSS) perspective and separately from a societal perspective. Costs (£ 2018–2019 prices) were collected prospectively over a 12 month follow-up period. A bivariate regression of costs and quality-adjusted life-years (QALYs), with multiple imputation of missing data, was conducted to estimate the incremental cost per QALY gained and the incremental net monetary benefit (INMB) of the BOOST programme in comparison to BPA. Sensitivity and pre-specified subgroup analyses explored uncertainty and heterogeneity in cost-effectiveness estimates. Results: Participants (N = 435) were randomised to the BOOST programme (n = 292) or BPA (n = 143). Mean (standard error [SE]) NHS and PSS costs over 12 months were £1,974 (£118) in the BOOST arm versus £1,827 (£169) in the BPA arm (p = 0.474). Mean (SE) QALY estimates were 0.620 (0.009) versus 0.599 (0.006), respectively (p = 0.093). The probability that the BOOST programme is cost-effective ranged between 67 and 83% (NHS and PSS perspective) and 79–89% (societal perspective) at cost-effectiveness thresholds between £15,000 and £30,000 per QALY gained. INMBs ranged between £145 and £464 at similar cost-effectiveness thresholds. The cost-effectiveness results remained robust to sensitivity analyses. Conclusions: The BOOST programme resulted in modest QALY gains over the 12 month follow-up period. Future studies with longer intervention and follow-up periods are needed to address uncertainty around the health-related quality of life impacts and cost-effectiveness of such programmes. Trial registration This study has been registered in the International Standard Randomised Controlled Trial Number registry, reference number ISRCTN12698674. Registered on 10 November 2015.
Item Type: | Journal Article | ||||||
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Subjects: | R Medicine > RD Surgery | ||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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SWORD Depositor: | Library Publications Router | ||||||
Library of Congress Subject Headings (LCSH): | Spinal canal -- Stenosis -- Psychological aspects, Lumbar vertebrae -- Surgery -- Cost effectiveness, Spine -- Diseases -- Age factors, Spinal canal -- Stenosis -- Treament -- costs, Quality of life -- Research, Lumbar vertebrae -- Exercise therapy, Lumbar vertebrae -- Treatment| -- Economic aspects, Spine -- Diseases -- Patients -- Rehabilitation | ||||||
Journal or Publication Title: | Cost effectiveness and resource allocation | ||||||
Publisher: | BioMed Central Ltd. | ||||||
ISSN: | 1478-7547 | ||||||
Official Date: | 8 February 2023 | ||||||
Dates: |
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Volume: | 21 | ||||||
Number: | 1 | ||||||
Article Number: | 14 | ||||||
DOI: | 10.1186/s12962-022-00410-y | ||||||
Status: | Peer Reviewed | ||||||
Publication Status: | Published | ||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||
Date of first compliant deposit: | 15 March 2023 | ||||||
Date of first compliant Open Access: | 15 March 2023 | ||||||
RIOXX Funder/Project Grant: |
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