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Selective dorsal rhizotomy; evidence on cost-effectiveness from England
OBJECTIVES: Selective dorsal rhizotomy (SDR) has gained interest as an intervention to reduce spasticity and pain, and improve quality of life and mobility in children with cerebral palsy mainly affecting the legs (diplegia). We evaluated the cost-effectiveness of SDR in England. METHODS: Cost-effec...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Public Library of Science
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7416930/ https://www.ncbi.nlm.nih.gov/pubmed/32776949 http://dx.doi.org/10.1371/journal.pone.0236783 |
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author | Pennington, Mark Summers, Jennifer Coker, Bola Eddy, Saskia Kartha, Muralikrishnan R. Edwards, Karen Freeman, Robert Goodden, John Powell, Helen Verity, Christopher Peacock, Janet L. |
author_facet | Pennington, Mark Summers, Jennifer Coker, Bola Eddy, Saskia Kartha, Muralikrishnan R. Edwards, Karen Freeman, Robert Goodden, John Powell, Helen Verity, Christopher Peacock, Janet L. |
author_sort | Pennington, Mark |
collection | PubMed |
description | OBJECTIVES: Selective dorsal rhizotomy (SDR) has gained interest as an intervention to reduce spasticity and pain, and improve quality of life and mobility in children with cerebral palsy mainly affecting the legs (diplegia). We evaluated the cost-effectiveness of SDR in England. METHODS: Cost-effectiveness was quantified with respect to Gross Motor Function Measure (GMFM-66) and the pain dimension of the Cerebral Palsy Quality of Life questionnaire for Children (CPQOL-Child). Data on outcomes following SDR over two years were drawn from a national evaluation in England which included 137 children, mean age 6.6 years at surgery. The incremental impact of SDR on GMFM-66 was determined through comparison with data from a historic Canadian cohort not undergoing SDR. Another single centre provided data on hospital care over ten years for 15 children undergoing SDR at a mean age of 7.0 years, and a comparable cohort managed without SDR. The incremental impact of SDR on pain was determined using a before and after comparison using data from the national evaluation. Missing data were imputed using multiple imputation. Incremental costs of SDR were determined as the difference in costs over 5 years for the patients undergoing SDR and those managed without SDR. Uncertainty was quantified using bootstrapping and reported as the cost-effectiveness acceptability curve. RESULTS: In the base case, the incremental cost-effectiveness ratios (ICERs) for SDR are £1,382 and £903 with respect to a unit improvement in GMFM-66 and the pain dimension of CPQOL-Child, respectively. Inclusion of data to 10 years indicates SDR is cheaper than management without SDR. Incremental costs and ICERs for SDR rose in sensitivity analysis applying an alternative regression model to cost data. CONCLUSIONS: Data on outcomes from a large observational study of SDR and long-term cost data on children who did and did not receive SDR indicates SDR is cost-effective. |
format | Online Article Text |
id | pubmed-7416930 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-74169302020-08-19 Selective dorsal rhizotomy; evidence on cost-effectiveness from England Pennington, Mark Summers, Jennifer Coker, Bola Eddy, Saskia Kartha, Muralikrishnan R. Edwards, Karen Freeman, Robert Goodden, John Powell, Helen Verity, Christopher Peacock, Janet L. PLoS One Research Article OBJECTIVES: Selective dorsal rhizotomy (SDR) has gained interest as an intervention to reduce spasticity and pain, and improve quality of life and mobility in children with cerebral palsy mainly affecting the legs (diplegia). We evaluated the cost-effectiveness of SDR in England. METHODS: Cost-effectiveness was quantified with respect to Gross Motor Function Measure (GMFM-66) and the pain dimension of the Cerebral Palsy Quality of Life questionnaire for Children (CPQOL-Child). Data on outcomes following SDR over two years were drawn from a national evaluation in England which included 137 children, mean age 6.6 years at surgery. The incremental impact of SDR on GMFM-66 was determined through comparison with data from a historic Canadian cohort not undergoing SDR. Another single centre provided data on hospital care over ten years for 15 children undergoing SDR at a mean age of 7.0 years, and a comparable cohort managed without SDR. The incremental impact of SDR on pain was determined using a before and after comparison using data from the national evaluation. Missing data were imputed using multiple imputation. Incremental costs of SDR were determined as the difference in costs over 5 years for the patients undergoing SDR and those managed without SDR. Uncertainty was quantified using bootstrapping and reported as the cost-effectiveness acceptability curve. RESULTS: In the base case, the incremental cost-effectiveness ratios (ICERs) for SDR are £1,382 and £903 with respect to a unit improvement in GMFM-66 and the pain dimension of CPQOL-Child, respectively. Inclusion of data to 10 years indicates SDR is cheaper than management without SDR. Incremental costs and ICERs for SDR rose in sensitivity analysis applying an alternative regression model to cost data. CONCLUSIONS: Data on outcomes from a large observational study of SDR and long-term cost data on children who did and did not receive SDR indicates SDR is cost-effective. Public Library of Science 2020-08-10 /pmc/articles/PMC7416930/ /pubmed/32776949 http://dx.doi.org/10.1371/journal.pone.0236783 Text en © 2020 Pennington et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Pennington, Mark Summers, Jennifer Coker, Bola Eddy, Saskia Kartha, Muralikrishnan R. Edwards, Karen Freeman, Robert Goodden, John Powell, Helen Verity, Christopher Peacock, Janet L. Selective dorsal rhizotomy; evidence on cost-effectiveness from England |
title | Selective dorsal rhizotomy; evidence on cost-effectiveness from England |
title_full | Selective dorsal rhizotomy; evidence on cost-effectiveness from England |
title_fullStr | Selective dorsal rhizotomy; evidence on cost-effectiveness from England |
title_full_unstemmed | Selective dorsal rhizotomy; evidence on cost-effectiveness from England |
title_short | Selective dorsal rhizotomy; evidence on cost-effectiveness from England |
title_sort | selective dorsal rhizotomy; evidence on cost-effectiveness from england |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7416930/ https://www.ncbi.nlm.nih.gov/pubmed/32776949 http://dx.doi.org/10.1371/journal.pone.0236783 |
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