Cost‐effectiveness of steroid (methylprednisolone) injections versus anaesthetic alone for the treatment of Morton's neuroma: economic evaluation alongside a randomised controlled trial (MortISE trial)
Abstract Background Morton's neuroma is a common foot condition affecting health‐related quality of life. Though its management frequently includes steroid injections, evidence of cost‐effectiveness is sparse. So, we aimed to evaluate whether steroid injection is cost‐effective in treating Mort...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2015-01-01
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| Series: | Journal of Foot and Ankle Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13047-015-0064-y |
| _version_ | 1797321407967789056 |
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| author | Rhiannon Tudor Edwards Seow Tien Yeo Daphne Russell Colin E Thomson Ian Beggs J N Alastair Gibson Diane McMillan Denis J Martin Ian T Russell |
| author_facet | Rhiannon Tudor Edwards Seow Tien Yeo Daphne Russell Colin E Thomson Ian Beggs J N Alastair Gibson Diane McMillan Denis J Martin Ian T Russell |
| author_sort | Rhiannon Tudor Edwards |
| collection | DOAJ |
| description | Abstract Background Morton's neuroma is a common foot condition affecting health‐related quality of life. Though its management frequently includes steroid injections, evidence of cost‐effectiveness is sparse. So, we aimed to evaluate whether steroid injection is cost‐effective in treating Morton's neuroma compared with anaesthetic injection alone. Methods We undertook incremental cost‐effectiveness and cost‐utility analyses from the perspective of the National Health Service, alongside a patient‐blinded pragmatic randomised trial in hospital‐based orthopaedic outpatient clinics in Edinburgh, UK. Of the original randomised sample of 131 participants with Morton's neuroma (including 67 controls), economic analysis focused on 109 (including 55 controls). Both groups received injections guided by ultrasound. We estimated the incremental cost per point improvement in the area under the curve of the Foot Health Thermometer (FHT‐AUC) until three months after injection. We also conducted cost‐utility analyses using European Quality of life‐5 Dimensions–3 Levels (EQ‐5D‐3L), enhanced by the Foot Health Thermometer (FHT), to estimate utility and thus quality‐adjusted life years (QALYs). Results The unit cost of an ultrasound‐guided steroid injection was £149. Over the three months of follow‐up, the mean cost of National Health Service resources was £280 for intervention participants and £202 for control participants – a difference of £79 [bootstrapped 95% confidence interval (CI): £18 to £152]. The corresponding estimated incremental cost‐effectiveness ratio was £32 per point improvement in the FHT‐AUC (bootstrapped 95% CI: £7 to £100). If decision makers value improvement of one point at £100 (the upper limit of this CI), there is 97.5% probability that steroid injection is cost‐effective. As EQ‐5D‐3L seems unresponsive to changes in foot health, we based secondary cost‐utility analysis on the FHT‐enhanced EQ‐5D. This estimated the corresponding incremental cost‐effectiveness ratio as £6,400 per QALY. Over the recommended UK threshold, ranging from £20,000 to £30,000 per QALY, there is 80%‐85% probability that steroid injection is cost‐effective. Conclusions Steroid injections are effective and cost‐effective in relieving foot pain measured by the FHT for three months. However, cost‐utility analysis was initially inconclusive because the EQ‐5D‐3L is less responsive than the FHT to changes in foot health. By using the FHT to enhance the EQ‐5D, we inferred that injections yield good value in cost per QALY. Trial registration Current Controlled Trials ISRCTN13668166 |
| first_indexed | 2024-03-08T04:58:11Z |
| format | Article |
| id | doaj.art-1f63f5defca04ce59ed4402e48abf001 |
| institution | Directory Open Access Journal |
| issn | 1757-1146 |
| language | English |
| last_indexed | 2024-03-08T04:58:11Z |
| publishDate | 2015-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Foot and Ankle Research |
| spelling | doaj.art-1f63f5defca04ce59ed4402e48abf0012024-02-07T14:57:49ZengWileyJournal of Foot and Ankle Research1757-11462015-01-0181n/an/a10.1186/s13047-015-0064-yCost‐effectiveness of steroid (methylprednisolone) injections versus anaesthetic alone for the treatment of Morton's neuroma: economic evaluation alongside a randomised controlled trial (MortISE trial)Rhiannon Tudor Edwards0Seow Tien Yeo1Daphne Russell2Colin E Thomson3Ian Beggs4J N Alastair Gibson5Diane McMillan6Denis J Martin7Ian T Russell8Bangor UniversityCentre for Health Economics and Medicines Evaluation (CHEME)School of Healthcare SciencesCollege of Health and Behavioural Sciences (CoHaBS)Ardudwy Hall, Normal SiteLL57 2PZBangorGwyneddUKBangor UniversityCentre for Health Economics and Medicines Evaluation (CHEME)School of Healthcare SciencesCollege of Health and Behavioural Sciences (CoHaBS)Ardudwy Hall, Normal SiteLL57 2PZBangorGwyneddUKSwansea UniversitySingleton ParkInstitute of Life Science 2College of MedicineSA2 8PPSwanseaUKHealth SciencesQueen Margaret UniversityQueen Margaret University DriveEH21 6UUEdinburghScotland, UKThe Royal Infirmary of Edinburgh51 Little France CrescentDepartment of RadiologyOld Dalkeith RoadEH16 4SAEdinburghScotland, UKMusculoskeletal DirectorateThe Royal Infirmary of Edinburgh51 Little France Crescent, Old Dalkeith RoadEH16 4SAEdinburghScotland, UKHealth SciencesQueen Margaret UniversityQueen Margaret University DriveEH21 6UUEdinburghScotland, UKTeesside UniversityHealth and Social Care InstituteTS1 3BAMiddlesbroughUKSwansea UniversitySingleton ParkInstitute of Life Science 2College of MedicineSA2 8PPSwanseaUKAbstract Background Morton's neuroma is a common foot condition affecting health‐related quality of life. Though its management frequently includes steroid injections, evidence of cost‐effectiveness is sparse. So, we aimed to evaluate whether steroid injection is cost‐effective in treating Morton's neuroma compared with anaesthetic injection alone. Methods We undertook incremental cost‐effectiveness and cost‐utility analyses from the perspective of the National Health Service, alongside a patient‐blinded pragmatic randomised trial in hospital‐based orthopaedic outpatient clinics in Edinburgh, UK. Of the original randomised sample of 131 participants with Morton's neuroma (including 67 controls), economic analysis focused on 109 (including 55 controls). Both groups received injections guided by ultrasound. We estimated the incremental cost per point improvement in the area under the curve of the Foot Health Thermometer (FHT‐AUC) until three months after injection. We also conducted cost‐utility analyses using European Quality of life‐5 Dimensions–3 Levels (EQ‐5D‐3L), enhanced by the Foot Health Thermometer (FHT), to estimate utility and thus quality‐adjusted life years (QALYs). Results The unit cost of an ultrasound‐guided steroid injection was £149. Over the three months of follow‐up, the mean cost of National Health Service resources was £280 for intervention participants and £202 for control participants – a difference of £79 [bootstrapped 95% confidence interval (CI): £18 to £152]. The corresponding estimated incremental cost‐effectiveness ratio was £32 per point improvement in the FHT‐AUC (bootstrapped 95% CI: £7 to £100). If decision makers value improvement of one point at £100 (the upper limit of this CI), there is 97.5% probability that steroid injection is cost‐effective. As EQ‐5D‐3L seems unresponsive to changes in foot health, we based secondary cost‐utility analysis on the FHT‐enhanced EQ‐5D. This estimated the corresponding incremental cost‐effectiveness ratio as £6,400 per QALY. Over the recommended UK threshold, ranging from £20,000 to £30,000 per QALY, there is 80%‐85% probability that steroid injection is cost‐effective. Conclusions Steroid injections are effective and cost‐effective in relieving foot pain measured by the FHT for three months. However, cost‐utility analysis was initially inconclusive because the EQ‐5D‐3L is less responsive than the FHT to changes in foot health. By using the FHT to enhance the EQ‐5D, we inferred that injections yield good value in cost per QALY. Trial registration Current Controlled Trials ISRCTN13668166https://doi.org/10.1186/s13047-015-0064-yMorton's neuromaInterdigital plantar nervesMethylprednisoloneSteroid injectionFoot healthCost‐effectiveness analysis |
| spellingShingle | Rhiannon Tudor Edwards Seow Tien Yeo Daphne Russell Colin E Thomson Ian Beggs J N Alastair Gibson Diane McMillan Denis J Martin Ian T Russell Cost‐effectiveness of steroid (methylprednisolone) injections versus anaesthetic alone for the treatment of Morton's neuroma: economic evaluation alongside a randomised controlled trial (MortISE trial) Journal of Foot and Ankle Research Morton's neuroma Interdigital plantar nerves Methylprednisolone Steroid injection Foot health Cost‐effectiveness analysis |
| title | Cost‐effectiveness of steroid (methylprednisolone) injections versus anaesthetic alone for the treatment of Morton's neuroma: economic evaluation alongside a randomised controlled trial (MortISE trial) |
| title_full | Cost‐effectiveness of steroid (methylprednisolone) injections versus anaesthetic alone for the treatment of Morton's neuroma: economic evaluation alongside a randomised controlled trial (MortISE trial) |
| title_fullStr | Cost‐effectiveness of steroid (methylprednisolone) injections versus anaesthetic alone for the treatment of Morton's neuroma: economic evaluation alongside a randomised controlled trial (MortISE trial) |
| title_full_unstemmed | Cost‐effectiveness of steroid (methylprednisolone) injections versus anaesthetic alone for the treatment of Morton's neuroma: economic evaluation alongside a randomised controlled trial (MortISE trial) |
| title_short | Cost‐effectiveness of steroid (methylprednisolone) injections versus anaesthetic alone for the treatment of Morton's neuroma: economic evaluation alongside a randomised controlled trial (MortISE trial) |
| title_sort | cost effectiveness of steroid methylprednisolone injections versus anaesthetic alone for the treatment of morton s neuroma economic evaluation alongside a randomised controlled trial mortise trial |
| topic | Morton's neuroma Interdigital plantar nerves Methylprednisolone Steroid injection Foot health Cost‐effectiveness analysis |
| url | https://doi.org/10.1186/s13047-015-0064-y |
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