Which surgical treatment for Dupuytren’s Contracture is most cost-effective in England?
<p>Objectives: To assess the cost-effectiveness of surgical interventions offered in the NHS for adults with Dupuytren’s contracture admitted into secondary care, when compared to the mainstay of surgical treatment (Limited Fasciectomy).</p> <p>Perspective: From the healthcare pay...
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| Other Authors: | |
| Format: | Thesis |
| Language: | English |
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2020
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| _version_ | 1817932210772115456 |
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| author | Singh, G |
| author2 | Furniss, D |
| author_facet | Furniss, D Singh, G |
| author_sort | Singh, G |
| collection | OXFORD |
| description | <p>Objectives: To assess the cost-effectiveness of surgical interventions offered in the NHS for adults with Dupuytren’s contracture admitted into secondary care, when compared to the mainstay of surgical treatment (Limited Fasciectomy).</p>
<p>Perspective: From the healthcare payer’s perspective, which would be NHS
England.</p>
<p>Setting: Inpatient admitted secondary care in the NHS in England.</p>
<p>Methods: A 34-year time horizon economic evaluation was conducted using
individual patient data from Hospital Episode Statistics, the UK Hand Registry, and National Life Tables. A de novo cohort Markov model was developed to assess the cost-effectiveness of admitted patient Percutaneous Needle Fasciotomy (PNF), and Dermofasciectomy (DF) to Limited Fasciectomy (LF) as a comparator. This accounts for factors like life expectancy and further treatment for each year after the average age of treatment. Deterministic and probabilistic sensitivity analyses were
undertaken to study model and parameter uncertainty.</p>
<p>Results: Using the incremental cost-effectiveness ratio, LF was the dominant
procedure. For one less QALY, DF would cost an additional £1030.76 and admitted patient PNF would cost an additional £2207.96. Running one-way sensitivity analysis shows that modifying the cost and utility parameter values doesn’t result in a different outcome. Probabilistic sensitivity analysis suggests that there is a maximum probability of 55% that LF is the most cost-effective procedure.</p>
<p>Conclusions: This supports LF as the treatment of choice for first-line surgical treatment, compared to DF or admitted patient PNF administered through inpatient admitted care pathways. Constraints of the datasets, namely follow up as well as information on other settings, limited the relevance of this model to other settings. Further research might focus on differing severity of disease, and compare other pathways, such as outpatient PNF, which might be expected to have different costs. Randomised controlled trial data would be beneficial to extend this study and add granularity to the observational data available.</p> |
| first_indexed | 2024-03-06T19:41:52Z |
| format | Thesis |
| id | oxford-uuid:20f869c7-6eb4-4a78-b9bd-a8e88579875e |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-12-09T03:34:18Z |
| publishDate | 2020 |
| record_format | dspace |
| spelling | oxford-uuid:20f869c7-6eb4-4a78-b9bd-a8e88579875e2024-12-01T17:51:01ZWhich surgical treatment for Dupuytren’s Contracture is most cost-effective in England?Thesishttp://purl.org/coar/resource_type/c_bdccuuid:20f869c7-6eb4-4a78-b9bd-a8e88579875eSurgery, PlasticCost effectivenessEnglishHyrax Deposit2020Singh, GFurniss, DRodrigues, JNPinedo-Villanueva, RAKolovos, S<p>Objectives: To assess the cost-effectiveness of surgical interventions offered in the NHS for adults with Dupuytren’s contracture admitted into secondary care, when compared to the mainstay of surgical treatment (Limited Fasciectomy).</p> <p>Perspective: From the healthcare payer’s perspective, which would be NHS England.</p> <p>Setting: Inpatient admitted secondary care in the NHS in England.</p> <p>Methods: A 34-year time horizon economic evaluation was conducted using individual patient data from Hospital Episode Statistics, the UK Hand Registry, and National Life Tables. A de novo cohort Markov model was developed to assess the cost-effectiveness of admitted patient Percutaneous Needle Fasciotomy (PNF), and Dermofasciectomy (DF) to Limited Fasciectomy (LF) as a comparator. This accounts for factors like life expectancy and further treatment for each year after the average age of treatment. Deterministic and probabilistic sensitivity analyses were undertaken to study model and parameter uncertainty.</p> <p>Results: Using the incremental cost-effectiveness ratio, LF was the dominant procedure. For one less QALY, DF would cost an additional £1030.76 and admitted patient PNF would cost an additional £2207.96. Running one-way sensitivity analysis shows that modifying the cost and utility parameter values doesn’t result in a different outcome. Probabilistic sensitivity analysis suggests that there is a maximum probability of 55% that LF is the most cost-effective procedure.</p> <p>Conclusions: This supports LF as the treatment of choice for first-line surgical treatment, compared to DF or admitted patient PNF administered through inpatient admitted care pathways. Constraints of the datasets, namely follow up as well as information on other settings, limited the relevance of this model to other settings. Further research might focus on differing severity of disease, and compare other pathways, such as outpatient PNF, which might be expected to have different costs. Randomised controlled trial data would be beneficial to extend this study and add granularity to the observational data available.</p> |
| spellingShingle | Surgery, Plastic Cost effectiveness Singh, G Which surgical treatment for Dupuytren’s Contracture is most cost-effective in England? |
| title | Which surgical treatment for Dupuytren’s Contracture is most cost-effective in England? |
| title_full | Which surgical treatment for Dupuytren’s Contracture is most cost-effective in England? |
| title_fullStr | Which surgical treatment for Dupuytren’s Contracture is most cost-effective in England? |
| title_full_unstemmed | Which surgical treatment for Dupuytren’s Contracture is most cost-effective in England? |
| title_short | Which surgical treatment for Dupuytren’s Contracture is most cost-effective in England? |
| title_sort | which surgical treatment for dupuytren s contracture is most cost effective in england |
| topic | Surgery, Plastic Cost effectiveness |
| work_keys_str_mv | AT singhg whichsurgicaltreatmentfordupuytrenscontractureismostcosteffectiveinengland |