Presentation (CTI)

OBJECTIVES: To evaluate the potential economic value and under which scenarios a novel orthotic care pathway incorporating additive manufacturing for hand osteoarthritis management can be a cost-effective alternative for use in the NHS.
METHODS: A decision-tree model was developed from the NHS perspective to evaluate scenarios for the integration of a novel orthotic care pathway for patients with hand osteoarthritis in the NHS compared against the standard of care. Model structure and health states were informed by the literature, clinician interviews and published clinical guidelines. Utilities were derived from studies reporting EQ-5D outcomes, while direct healthcare costs were obtained from NHS Reference Costs and the Unit Costs of Health and Social Care. Scenario analysis and threshold analysis were used to assess the minimum requirements and potential maximum reimbursable price of the technology to achieve cost-effectiveness under the NHS willingness to pay thresholds. Estimates were obtained via a probabilistic sensitivity analysis to control for parameter uncertainty on the input parameters.
RESULTS: The maximum reimbursable price compatible with a £20,000/QALY willingness-to-pay threshold ranged from £10 to £425 depending on different levels of clinical effectiveness (3% to 5% increase in achieving acceptable condition). At a £30,000/QALY threshold, the corresponding range increased to £85-£717. Improvements in treatment effectiveness had a greater impact on reimbursable price than improvements in utility. A conservative effectiveness increase of 6% effectiveness and a MRP of £200 that allows further technology development produced an ICER of £18,994 and produced a probability of cost-effectiveness of 69.65%. This indicates that a novel pathway integrating additive manufacturing can be a cost-effective strategy at the £20,000 per QALY gained threshold.
CONCLUSIONS: Threshold analyses suggest that treatment effectiveness is the principal driver of cost-effectiveness. The adoption of a novel additive manufacturing orthotic pathway for hand osteoarthritis can be cost-effective if the improvements in the treatment effectiveness are sustained.