Cost-effectiveness of steroid

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 [pounds sterling]149. Over the three months of follow-up, the mean cost of National Health Service resources was [pounds sterling]280 for intervention participants and [pounds sterling]202 for control participants - a difference of [pounds sterling]79 [bootstrapped 95% confidence interval (CI): [pounds sterling]18 to [pounds sterling]152]. The corresponding estimated incremental cost-effectiveness ratio was [pounds sterling]32 per point improvement in the FHT-AUC (bootstrapped 95% CI: [pounds sterling]7 to [pounds sterling]100). If decision makers value improvement of one point at [pounds sterling]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 [pounds sterling]6,400 per QALY. Over the recommended UK threshold, ranging from [pounds sterling]20,000 to [pounds sterling]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.