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Is shared care with annual hospital review better value for money than predominantly hospital-based care in patients with established stable rheumatoid arthritis?
  1. Linda Mary Davies1,
  2. Emily Anne Fargher2,
  3. Karen Tricker2,
  4. Peter Dawes3,
  5. David L Scott4,
  6. Deborah Symmons5
  1. 1Health Economics Research at Manchester, University of Manchester, Manchester, UK
  2. 2North West Genetics Knowledge Park, University of Manchester, Manchester, UK
  3. 3Department of Rheumatology, University of North Staffordshire NHS Trust, Stoke on Trent, Staffordshire, UK
  4. 4Academic Rheumatology Unit, King’s College Hospital NHS Trust, London, UK
  5. 5ARC Epidemiology Unit, University of Manchester, Manchester, UK
  1. Correspondence to:
    L Davies
    University Department of Psychiatry, Rawnsley Building, MRI, Oxford Road, Manchester M13 9WL, UK; linda.davies{at}


Objective: 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 randomised controlled trial of SCSC and ATH. A broad perspective was used (UK National Health Service, 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.

Results: The mean (SD) cost per person was £4540 (4700) in the SCSC group and £4440 (4900) in the ATH group. The mean (SD) QALYs per person for 3 years were 1.67 (0.56) in the SCSC group and 1.60 (0.60) in the ATH group. If decision makers are prepared to pay ⩾£2000 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 that SCSC is likely to be more cost effective than ATH in 60–90% of cases. This result seems to be robust to assumptions required by the analysis. This study is one of a limited number of randomised controlled trials 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 EuroQol.

  • ATH, aggressive treatment delivered in hospital
  • BROSG, British Rheumatoid Outcome Study Group
  • CEAA, cost effectiveness acceptability
  • DMARD, disease modifying antirheumatic drug
  • EQ-5D, EuroQol
  • GP, general practitioner
  • HAQ, Health Assessment Questionnaire
  • ICER, incremental cost effectiveness ratio
  • QALY, quality adjusted life year
  • RA, rheumatoid arthritis
  • SCSC, symptom control delivered by shared care

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  • Published Online First 23 November 2006

  • Funding: This study was funded by the UK Department of Health through its Health Technology Assessment Programme. The study was funded following acceptance of a detailed peer-reviewed proposal.

  • Competing interests: None declared.

  • The proposal was submitted in response to a commissioning brief requesting tenders published by the funding body. The funding body had no involvement in study design, data collection, analysis or interpretation of the results, writing of this paper, or in the decision to submit the paper for publication. The opinions and conclusions expressed here are those of the authors and do not necessarily reflect those of the UK National Health Service or the Department of Health.

    Financial interests: The sponsors of the project, the NCCHTA, have an agreement with the BMJ to allow all NHS-funded research to be published under a non-exclusive licence, as it falls under Crown copyright and so an exclusive license cannot be assigned by the author to the journal.

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