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dc.contributor.authorMandy, M
dc.contributor.authorKamran, K
dc.contributor.authorMarian, IR
dc.contributor.authorDutton, SJ
dc.contributor.authorEsther, W
dc.contributor.authorLamb, SE
dc.contributor.authorStavros, P
dc.date.accessioned2023-03-01T08:57:10Z
dc.date.issued2023-02-08
dc.date.updated2023-02-28T16:24:47Z
dc.description.abstractBACKGROUND: Emerging evidence suggests that structured and progressive exercise underpinned by a cognitive behavioural approach can improve functional outcomes in patients with neurogenic claudication (NC). However, evidence surrounding its economic benefits is lacking. OBJECTIVES: To estimate the economic costs, health-related quality of life outcomes and cost-effectiveness of a physical and psychological group intervention (BOOST programme) versus best practice advice (BPA) in older adults with NC. METHODS: An economic evaluation was conducted based on data from a pragmatic, multicentre, superiority, randomised controlled trial. The base-case economic evaluation took the form of an intention-to-treat analysis conducted from a UK National Health Service (NHS) and personal social services (PSS) perspective and separately from a societal perspective. Costs (£ 2018-2019 prices) were collected prospectively over a 12 month follow-up period. A bivariate regression of costs and quality-adjusted life-years (QALYs), with multiple imputation of missing data, was conducted to estimate the incremental cost per QALY gained and the incremental net monetary benefit (INMB) of the BOOST programme in comparison to BPA. Sensitivity and pre-specified subgroup analyses explored uncertainty and heterogeneity in cost-effectiveness estimates. RESULTS: Participants (N = 435) were randomised to the BOOST programme (n = 292) or BPA (n = 143). Mean (standard error [SE]) NHS and PSS costs over 12 months were £1,974 (£118) in the BOOST arm versus £1,827 (£169) in the BPA arm (p = 0.474). Mean (SE) QALY estimates were 0.620 (0.009) versus 0.599 (0.006), respectively (p = 0.093). The probability that the BOOST programme is cost-effective ranged between 67 and 83% (NHS and PSS perspective) and 79-89% (societal perspective) at cost-effectiveness thresholds between £15,000 and £30,000 per QALY gained. INMBs ranged between £145 and £464 at similar cost-effectiveness thresholds. The cost-effectiveness results remained robust to sensitivity analyses. CONCLUSIONS: The BOOST programme resulted in modest QALY gains over the 12 month follow-up period. Future studies with longer intervention and follow-up periods are needed to address uncertainty around the health-related quality of life impacts and cost-effectiveness of such programmes. Trial registration This study has been registered in the International Standard Randomised Controlled Trial Number registry, reference number ISRCTN12698674. Registered on 10 November 2015.en_GB
dc.description.sponsorshipNational Institute for Health Research (NIHR)en_GB
dc.format.extent14-
dc.format.mediumElectronic
dc.identifier.citationVol. 21 (1), article 14en_GB
dc.identifier.doihttps://doi.org/10.1186/s12962-022-00410-y
dc.identifier.grantnumberPTC-RP-PG-0213-20002en_GB
dc.identifier.urihttp://hdl.handle.net/10871/132577
dc.identifierORCID: 0000-0003-4349-7195 (Lamb, Sarah E)
dc.identifierScopusID: 7101956142 (Lamb, Sarah E)
dc.language.isoenen_GB
dc.publisherBMCen_GB
dc.relation.urlhttps://www.ncbi.nlm.nih.gov/pubmed/36755265en_GB
dc.rights© The Author(s) 2023. Open Access. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.en_GB
dc.subjectCost-effectivenessen_GB
dc.subjectEconomic costsen_GB
dc.subjectExerciseen_GB
dc.subjectHealth-related quality of lifeen_GB
dc.subjectNeurogenic claudicationen_GB
dc.subjectPsychosocialen_GB
dc.subjectRehabilitationen_GB
dc.subjectSpinal stenosisen_GB
dc.titleEconomic costs, health-related quality of life outcomes and cost-utility of a physical and psychological group intervention targeted at older adults with neurogenic claudicationen_GB
dc.typeArticleen_GB
dc.date.available2023-03-01T08:57:10Z
exeter.article-number14
exeter.place-of-publicationEngland
dc.descriptionThis is the final version. Available from BMC via the DOI in this record. en_GB
dc.descriptionThe datasets analysed during the current study are available from the corresponding author upon reasonable request.en_GB
dc.identifier.eissn1478-7547
dc.identifier.journalCost Effectiveness and Resource Allocationen_GB
dc.relation.ispartofCost Eff Resour Alloc, 21(1)
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en_GB
dcterms.dateAccepted2022-12-16
dc.rights.licenseCC BY
rioxxterms.versionVoRen_GB
rioxxterms.licenseref.startdate2022-12-16
rioxxterms.typeJournal Article/Reviewen_GB
refterms.dateFCD2023-03-01T08:50:01Z
refterms.versionFCDVoR
refterms.dateFOA2023-03-01T08:57:13Z
refterms.panelAen_GB
refterms.dateFirstOnline2023-02-08


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© The Author(s) 2023. Open Access. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Except where otherwise noted, this item's licence is described as © The Author(s) 2023. Open Access. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.