ArticleBone & joint open2025
Cost utility analysis of acute rehabilitation approaches in the management of traumatic anterior shoulder dislocation.
Article in Bone & joint open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
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Corrections and comments
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Authors and funding
8 authors.
Funding
Abstract
Aims: We aimed to conduct a cost-utility analysis comparing one session of advice, supporting materials, and option to self-refer to physiotherapy with the same advice and materials, plus an additional programme of physiotherapy for people with a first-time, traumatic anterior shoulder dislocation. Methods: We conducted an economic evaluation within a randomized controlled trial from the UK NHS and personal social services (PSS) perspective. Resources used, and health-related quality of life information, were collected as part of the Acute Rehabilitation following Traumatic anterior shoulder dISlocAtioN (ARTISAN) randomized controlled trial over a 12-month period using patient-completed questionnaires. Incremental costs and quality-adjusted life-years (QALYs) accrued over the follow-up period were calculated and expressed as the incremental cost-effectiveness ratio (ICER). Estimate uncertainty was explored by bootstrapping and graphically displayed on the ICER plane. Net monetary benefits, probability of cost-effectiveness, and expected value of perfect information were explored at a range of willingness-to-pay thresholds and visualized graphically. Results: Over a 12-month time horizon, incremental costs were £64 (95% CI -61 to 191) and incremental QALYs were 0.019 (95% CI -0.0005 to 0.0375) for the additional programme of physiotherapy. The ICER was £3,373/QALY, suggesting that the programme is cost-effective, although the primary outcome (Oxford Shoulder Instability Score) found little difference six months after a shoulder dislocation. The probability of being cost-effective at a willingness-to-pay threshold of £30,000 per QALY is 95%. Findings need to interpreted with caution given the high rates of missing data at 12 months, due to the final 12-month follow-up being curtailed during the trial. However, the range of sensitivity analyses supports the base case findings. Conclusion: The within-trial economic evaluation found that the additional physiotherapy programme is likely to be cost-effective. However, given the small and imprecise health gains, the best use of scarce physiotherapy resources needs careful consideration given other current demands on services.
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Registered trials
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