目的:一项务实的多中心随机对照试验,英国FROzen肩部试验(英国FROST),在英国NHS进行,比较了二级保健中成人原发性肩周炎常用治疗方法的成本效益.
方法:从NHS的角度进行了成本效用分析。麻醉操作(MUA)之间的差异,关节镜下囊膜松解术(ACR),使用早期结构化物理治疗加类固醇注射(ESP)的成本(2018年GBP价格基准)和1年质量调整生命年(QALYs),使用回归方法估算治疗的成本效益.
结果:ACR比ESP贵1,734英镑((95%置信区间(CI)1,529英镑至1,938英镑),比MUA贵1,457英镑(95%CI1,283英镑至1,632英镑)。MUA比ESP贵276英镑(95%CI为66英镑至487英镑)。总的来说,与MUA相比,ACR的QALYs更差(-0.0293;95%CI-0.0616至0.0030),与ESP相比,MUA的QALYs更好(0.0396;95%CI-0.0008至0.0800)。每QALY支付意愿门槛为20,000英镑,MUA具有最高的成本效益的可能性(0.8632),然后是ESP(0.1366)和ACR(0.0002)。结果对敏感性分析是稳健的。
结论:虽然ESP成本较低,MUA是最具成本效益的选择。ACR没有成本效益。引用这篇文章:BoneJtOpen2021;2(8):685-695。
OBJECTIVE: A pragmatic multicentre randomized controlled
trial, UK FROzen Shoulder
Trial (UK FROST), was conducted in the UK NHS comparing the cost-effectiveness of commonly used treatments for adults with primary frozen shoulder in secondary care.
METHODS: A cost utility analysis from the NHS perspective was performed. Differences between manipulation under anaesthesia (MUA), arthroscopic capsular release (ACR), and early structured physiotherapy plus steroid injection (ESP) in costs (2018 GBP price base) and quality adjusted life years (QALYs) at one year were used to estimate the cost-effectiveness of the treatments using regression methods.
RESULTS: ACR was £1,734 more costly than ESP ((95% confidence intervals (CIs) £1,529 to £1,938)) and £1,457 more costly than MUA (95% CI £1,283 to £1,632). MUA was £276 (95% CI £66 to £487) more expensive than ESP. Overall, ACR had worse QALYs compared with MUA (-0.0293; 95% CI -0.0616 to 0.0030) and MUA had better QALYs compared with ESP (0.0396; 95% CI -0.0008 to 0.0800). At a £20,000 per QALY willingness-to-pay threshold, MUA had the highest probability of being cost-effective (0.8632) then ESP (0.1366) and ACR (0.0002). The results were robust to sensitivity analyses.
CONCLUSIONS: While ESP was less costly, MUA was the most cost-effective option. ACR was not cost-effective. Cite this article: Bone Jt Open 2021;2(8):685-695.