title: Joint protection and hand exercises for hand osteoarthritis: an economic evaluation comparing methods for the analysis of factorial trials.
abstract: OBJECTIVE
  Evidence regarding the cost-effectiveness of joint protection and hand exercises for the management of hand OA is not well established. The primary aim of this study is to assess the cost-effectiveness (cost-utility) of these management options. In addition, given the absence of consensus regarding the conduct of economic evaluation alongside factorial trials, we compare different analytical methodologies.
  
  
  METHODS
  A trial-based economic evaluation to assess the cost-utility of joint protection only, hand exercises only and joint protection plus hand exercises compared with leaflet and advice was undertaken over a 12 month period from a UK National Health Service perspective. Patient-level mean costs and mean quality-adjusted life years (QALYs) were calculated for each trial arm. Incremental cost-effectiveness ratios (ICERs) were estimated and cost-effectiveness acceptability curves were constructed. The base case analysis used a within-the-table analysis methodology. Two further methods were explored: the at-the-margins approach and a regression-based approach with or without an interaction term.
  
  
  RESULTS
  Mean costs (QALYs) were £58.46 (s.d. 0.662) for leaflet and advice, £92.12 (s.d. 0.659) for joint protection, £64.51 (s.d. 0.681) for hand exercises and £112.38 (s.d. 0.658) for joint protection plus hand exercises. In the base case, hand exercises were the cost-effective option, with an ICER of £318 per QALY gained. Hand exercises remained the most cost-effective management strategy when adopting alternative methodological approaches.
  
  
  CONCLUSIONS
  This is the first trial evaluating the cost-effectiveness of occupational therapy-supported approaches to self-management for hand OA. Our findings showed that hand exercises were the most cost-effective option.
authors.affiliation: Arthritis Research UK Primary Care Centre, Keele University, Keele, Health Economics Unit, School of Health & Population Sciences, University of Birmingham, Birmingham, UK, Faculty of Health Sciences, Simon Fraser University, Burnaby, Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada and Centre for Health Sciences Research, University of Salford, Salford, UK Arthritis Research UK Primary Care Centre, Keele University, Keele, Health Economics Unit, School of Health & Population Sciences, University of Birmingham, Birmingham, UK, Faculty of Health Sciences, Simon Fraser University, Burnaby, Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada and Centre for Health Sciences Research, University of Salford, Salford, UK.
authors.forename: Raymond
authors.initials: R
authors.lastname: Oppong
authors.affiliation: Arthritis Research UK Primary Care Centre, Keele University, Keele, Health Economics Unit, School of Health & Population Sciences, University of Birmingham, Birmingham, UK, Faculty of Health Sciences, Simon Fraser University, Burnaby, Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada and Centre for Health Sciences Research, University of Salford, Salford, UK Arthritis Research UK Primary Care Centre, Keele University, Keele, Health Economics Unit, School of Health & Population Sciences, University of Birmingham, Birmingham, UK, Faculty of Health Sciences, Simon Fraser University, Burnaby, Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada and Centre for Health Sciences Research, University of Salford, Salford, UK s.jowett@bham.ac.uk.
authors.forename: Sue
authors.initials: S
authors.lastname: Jowett
authors.affiliation: Arthritis Research UK Primary Care Centre, Keele University, Keele, Health Economics Unit, School of Health & Population Sciences, University of Birmingham, Birmingham, UK, Faculty of Health Sciences, Simon Fraser University, Burnaby, Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada and Centre for Health Sciences Research, University of Salford, Salford, UK.
authors.forename: Elaine
authors.initials: E
authors.lastname: Nicholls
authors.affiliation: Arthritis Research UK Primary Care Centre, Keele University, Keele, Health Economics Unit, School of Health & Population Sciences, University of Birmingham, Birmingham, UK, Faculty of Health Sciences, Simon Fraser University, Burnaby, Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada and Centre for Health Sciences Research, University of Salford, Salford, UK Arthritis Research UK Primary Care Centre, Keele University, Keele, Health Economics Unit, School of Health & Population Sciences, University of Birmingham, Birmingham, UK, Faculty of Health Sciences, Simon Fraser University, Burnaby, Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada and Centre for Health Sciences Research, University of Salford, Salford, UK.
authors.forename: David G T
authors.initials: DG
authors.lastname: Whitehurst
authors.affiliation: Arthritis Research UK Primary Care Centre, Keele University, Keele, Health Economics Unit, School of Health & Population Sciences, University of Birmingham, Birmingham, UK, Faculty of Health Sciences, Simon Fraser University, Burnaby, Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada and Centre for Health Sciences Research, University of Salford, Salford, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Hill
authors.affiliation: Arthritis Research UK Primary Care Centre, Keele University, Keele, Health Economics Unit, School of Health & Population Sciences, University of Birmingham, Birmingham, UK, Faculty of Health Sciences, Simon Fraser University, Burnaby, Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada and Centre for Health Sciences Research, University of Salford, Salford, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Hammond
authors.affiliation: Arthritis Research UK Primary Care Centre, Keele University, Keele, Health Economics Unit, School of Health & Population Sciences, University of Birmingham, Birmingham, UK, Faculty of Health Sciences, Simon Fraser University, Burnaby, Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada and Centre for Health Sciences Research, University of Salford, Salford, UK.
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Hay
authors.affiliation: Arthritis Research UK Primary Care Centre, Keele University, Keele, Health Economics Unit, School of Health & Population Sciences, University of Birmingham, Birmingham, UK, Faculty of Health Sciences, Simon Fraser University, Burnaby, Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada and Centre for Health Sciences Research, University of Salford, Salford, UK.
authors.forename: Krysia
authors.initials: K
authors.lastname: Dziedzic
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis / Q000379:methods*; D005260:Female; D050823:Hand Joints; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000628:therapy*; D026741:Physical Therapy Modalities / Q000191:economics*; D011482:Protective Devices / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012044:Regression Analysis; D013222:State Medicine; D016896:Treatment Outcome; D006113:United Kingdom
keywords: cost-effectiveness; cost-utility; factorial trial; hand osteoarthritis