Rheumatology Advance Access originally published online on March 3, 2009
Rheumatology 2009 48(5):558-563; doi:10.1093/rheumatology/kep008
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Shoulder acute pain in primary health care: is retraining GPs effective? The SAPPHIRE randomized trial: a cost–effectiveness analysis
1Centre for Health Economics, University of York, York, 2Department of Rheumatology, Barnsley District General Hospital, Barnsley, 3Primary Care Rheumatology Society, Northallerton, 4Rheumatology and Rehabilitation Research Unit, University of Leeds, Leeds, 5Department of Health Sciences, University of York, York, 6Institute of Medical and Social Care Research, University of Wales, Bangor and 7York Trials Unit, Department of Health Sciences, University of York, York, UK.
Correspondence to: Claire McKenna, Centre for Health Economics, University of York, York YO10 5DD, UK. E-mail: cm535{at}york.ac.uk
 |
Abstract |
|---|
Objectives. To assess the cost–effectiveness of providing practical training to general practitioners (GPs) in shoulder problems, and administering a local anaesthetic (lignocaine) vs steroidal (cortisone) injection.
Methods. A cost–effectiveness analysis conducted alongside a cluster randomized trial with a factorial design, in general practices across five centres within the UK. A total of 155 participant GPs were randomized to receive training or no training with 200 participants randomized to either lignocaine or cortisone. Health care costs, quality-adjusted life years (QALYs) and incremental cost per QALY gained over 1 year estimated from a health system and a societal perspective were the main outcomes measured.
Results. Over 1 year, training GPs costs on average an additional £211 (95% credibility interval –£237, £661) than no training and produces higher mean QALYs (0.075; –0.004, 0.154) per patient, yielding an incremental cost–effectiveness ratio of £2813 per QALY gained for trained GPs. Over the same period of 1 year, lignocaine costs an average of £122 more (–£232, £476) than cortisone and produces virtually no differential gain in mean QALYs (0.001; –0.068, 0.070), yielding an incremental cost per QALY gained of £122 000 for lignocaine compared with cortisone. Across a range of cost–effectiveness thresholds, cortisone is as cost effective to inject as lignocaine. The probability that training is cost effective is above 0.95 at thresholds above £20 000.
Conclusions. Providing practical training to GPs about shoulder problems is cost effective and there is little uncertainty regarding this decision. The choice between lignocaine and cortisone is more uncertain and it is likely that there is significant value of further research to reduce this uncertainty.
Trial registration. The International Standard Randomised Controlled Trial Number is 58 537 244.
KEY WORDS: Cost–effectiveness analysis, Quality-adjusted life years, Randomized trial, General practice, Shoulder pain, Injection, Training
Submitted 7 March 2008;
revised version accepted 13 January 2009.
CiteULike 
Connotea 
Del.icio.us What's this?