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Randomized Controlled Trial
. 2023 Jun 23;13(6):e063103.
doi: 10.1136/bmjopen-2022-063103.

Is multimodal occupational therapy in addition to usual care cost-effective in people with thumb carpometacarpal osteoarthritis? A cost-utility analysis of a randomised controlled trial

Anne Therese Tveter  1 , Linn Kleven  2 , Nina Osteras  3 , Randi Nossum  4 , Ruth Else Mehl Eide  5 , Åse Klokkeide  6 , Karin Hoegh Matre  5 , Monika Olsen  6 , Ingvild Kjeken  3
Affiliations
Randomized Controlled Trial

Is multimodal occupational therapy in addition to usual care cost-effective in people with thumb carpometacarpal osteoarthritis? A cost-utility analysis of a randomised controlled trial

Anne Therese Tveter et al. BMJ Open. .

Abstract

Objective: The aim was to evaluate the cost-utility of a 3-month multimodal occupational therapy intervention in addition to usual care in patients with thumb carpometacarpal osteoarthritis (CMC1 OA).

Methods: A cost-utility analysis was performed alongside a multicentre randomised controlled trial including three rheumatology departments in Norway. A total of 180 patients referred to surgical consultation due to CMC1 OA were randomised to either multimodal occupational therapy including patient education, hand exercises, assistive devices and orthoses (n=90), or usual care receiving only information on OA (n=90). The outcome measure was quality-adjusted life-years (QALYs) derived from the generic questionnaire EQ-5D-5L over a 2-year period. Resource use and health-related quality of life of the patients were prospectively collected at baseline, 4, 18 and 24 months. Costs were estimated by taking a healthcare and societal perspective. The results were expressed as incremental cost-effectiveness ratios, and a probabilistic sensitivity analysis with 1000 replications following intention-to-treat principle was done to account for uncertainty in the analysis.

Results: During the 2-year follow-up period, patients receiving multimodal occupational therapy gained 0.06 more QALYs than patients receiving usual care. The mean (SD) direct costs were €3227 (3546) in the intervention group and €4378 (5487) in the usual care group, mean difference €-1151 (95% CI -2564, 262). The intervention was the dominant treatment with a probability of 94.5% being cost-effective given the willingness-to-pay threshold of €27 500.

Conclusions: The within-trial analysis demonstrated that the multimodal occupational therapy in addition to usual care was cost-effective at 2 years in patients with CMC1 OA.

Trial registration number: NCT01794754.

Keywords: hand & wrist; health economics; musculoskeletal disorders; rheumatology.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Cost-effectiveness (CE) plane of the incremental cost-effectiveness ratios of multimodal occupational therapy (intervention group) in addition to usual care (control group) were recalculated with 1000 replications of the study data using the bootstrap resampling method. The intervention is at the origin. QALYs, quality-adjusted life-years.
Figure 2
Figure 2
Cost-effectiveness acceptability curve for direct costs, representing the probability that the multimodal intervention is cost-effective in addition to usual care. At a willingness-to-pay threshold of €27 500/QALY, the probability of multimodal intervention being cost-effective was 94.5%. QALYs, quality-adjusted life-years.
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