Is shared care with annual hospital review better value for money than predominantly hospital based care in patients with established stable rheumatoid arthritis?

Linda Marie Davies ^1*, Emily Anne Fargher ¹, Karen Tricker ¹, Peter Dawes ², David L Scott ³ and Deborah Symmons ⁴

¹ University of Manchester, United Kingdom
² University of North Staffordshire NHS Trust, United Kingdom
³ King’s College Hospital NHS Trust, United Kingdom
⁴ ARC Epidemiology Unit, United Kingdom

^* To whom correspondence should be addressed. E-mail: linda.davies{at}manchester.ac.uk.

Accepted 30 October 2006

Abstract

Objectives:To assess the cost effectiveness and cost effectiveness acceptability of symptom control delivered by shared care (SCSC) and aggressive treatment delivered in hospital (ATH) for established rheumatoid arthritis (RA).

Methods:Economic data were collected within the British Rheumatoid Outcome Study Group (BROSG) randomised controlled trial of SCSC and ATH. A broad perspective was used (UK National Health Service (NHS), social support services and patients). Cost per Quality Adjusted Life Year (QALY) gained, net benefit statistics and cost effectiveness acceptability curves were estimated. Costs and outcomes were discounted at 3.5%. Sensitivity analysis tested the robustness of the results to analytical assumptions.

ResultsThe mean cost per person was £4540 (s.d. 4700) in the SCSC group and £4440 (s.d. £4900) in the ATH group. The mean QALYs per person for 3 years were 1.67 (s.d. 0.56) in the SCSC group and 1.60 (s.d. 0.60) in the ATH group. If decision makers are prepared to pay £2,000 or more to gain 1 QALY, SCSC is likely to be cost effective in 60%-90% of cases.

Conclusions:The primary economic analysis and sensitivity analyses indicate SCSC is likely to be more cost effective than ATH in 60%-90% of cases. This result appears to be robust to assumptions required by the analysis. This study is one of a limited number of RCTs to collect detailed resource use and health status data and estimate the costs and QALYs of treatment for established RA. This trial is one of the largest RA studies to use the EQ-5D.

Keywords: Economics,, QALY,, cost-effectiveness,, randomised controlled trial., rheumatoid arthritis,

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