TY - JOUR
T1 - 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)
AU - Edwards, Rhiannon
AU - Yeo, Seow
AU - Russell, Daphne
AU - Thomson, C. E. (Colin)
AU - Beggs, Ian
AU - Gibson, J. N. Alastair
AU - McMillan, Diane
AU - Martin, Denis
AU - Russell, Ian T.
PY - 2015/2/25
Y1 - 2015/2/25
N2 - 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
AB - 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
U2 - 10.1186/s13047-015-0064-y
DO - 10.1186/s13047-015-0064-y
M3 - Article
SN - 1757-1146
VL - 8
SP - -
JO - Journal of Foot and Ankle Research
JF - Journal of Foot and Ankle Research
IS - 6
ER -