Economic evaluation of early administration of prednisolone and/or aciclovir for the treatment of Bell's palsy

BELLS Trial Group

    Research output: Contribution to journalArticle

    13 Citations (Scopus)

    Abstract

    Objectives. Bell's palsy (BP), which causes facial paralysis, affects 11–40 people per 100?000 per annum in the UK. Its cause is unknown but as many as 30% of patients have continuing facial disfigurement, psychological difficulties and occasionally facial pain. We present an randomised controlled trial (RCT)-based economic evaluation of the early administration of steroids (prednisolone) and/or antivirals (acyclovir) compared to placebo, for treatment of BP.

    Methods. The RCT was not powered to detect differences in the cost-effectiveness; therefore, we adopted a decision analytic model approach as a way of gaining precision in our cost-effectiveness comparisons [e.g. prednisolone only (PO) versus acyclovir only versus prednisolone and acyclovir versus placebo, prednisolone versus no prednisolone (NP) and acyclovir versus no acyclovir]. We assumed that trial interventions affect the probability of being cured/not cured but their consequences are independent of the initial therapy. We used the percentage of individuals with a complete recovery (based on House–Brackmann grade?=?1) at 9 months and Quality Adjusted Life Years (e.g. derived on responses to the Health Utilities Index III) as measures of effectiveness. Other parameter estimates were obtained from trial data.

    Results. PO dominated—i.e. was less costly and more effective—all other therapy strategies in the four arms model [77% probability of cost-effective (CE)]. Moreover, Prednisolone dominated NP (77% probability of being CE at £30?000 threshold) while no acyclovir dominated aciclovir (85% chance of CE), in the two arms models, respectively.

    Conclusions. Treatment of BP with prednisolone is likely to be considered CE while treatment with acyclovir is highly unlikely to be considered CE. Further data on costs and utilities would be useful to confirm findings.
    Original languageEnglish
    Pages (from-to)137-144
    Number of pages8
    JournalFamily Practice
    Volume26
    Issue number2
    DOIs
    Publication statusPublished - Apr 2009

    Keywords

    • Acyclovir
    • Bell's palsy
    • Cost-effectiveness analysis
    • Economic evaluation
    • Prednisolone

    Cite this

    @article{23e72378032c4f11be495362f2f46477,
    title = "Economic evaluation of early administration of prednisolone and/or aciclovir for the treatment of Bell's palsy",
    abstract = "Objectives. Bell's palsy (BP), which causes facial paralysis, affects 11–40 people per 100?000 per annum in the UK. Its cause is unknown but as many as 30{\%} of patients have continuing facial disfigurement, psychological difficulties and occasionally facial pain. We present an randomised controlled trial (RCT)-based economic evaluation of the early administration of steroids (prednisolone) and/or antivirals (acyclovir) compared to placebo, for treatment of BP.Methods. The RCT was not powered to detect differences in the cost-effectiveness; therefore, we adopted a decision analytic model approach as a way of gaining precision in our cost-effectiveness comparisons [e.g. prednisolone only (PO) versus acyclovir only versus prednisolone and acyclovir versus placebo, prednisolone versus no prednisolone (NP) and acyclovir versus no acyclovir]. We assumed that trial interventions affect the probability of being cured/not cured but their consequences are independent of the initial therapy. We used the percentage of individuals with a complete recovery (based on House–Brackmann grade?=?1) at 9 months and Quality Adjusted Life Years (e.g. derived on responses to the Health Utilities Index III) as measures of effectiveness. Other parameter estimates were obtained from trial data.Results. PO dominated—i.e. was less costly and more effective—all other therapy strategies in the four arms model [77{\%} probability of cost-effective (CE)]. Moreover, Prednisolone dominated NP (77{\%} probability of being CE at £30?000 threshold) while no acyclovir dominated aciclovir (85{\%} chance of CE), in the two arms models, respectively.Conclusions. Treatment of BP with prednisolone is likely to be considered CE while treatment with acyclovir is highly unlikely to be considered CE. Further data on costs and utilities would be useful to confirm findings.",
    keywords = "Acyclovir, Bell's palsy, Cost-effectiveness analysis, Economic evaluation, Prednisolone",
    author = "Hernandez, {R. A.} and F. Sullivan and P. Donnan and I. Swan and L. Vale and Blair Smith and {BELLS Trial Group}",
    year = "2009",
    month = "4",
    doi = "10.1093/fampra/cmn107",
    language = "English",
    volume = "26",
    pages = "137--144",
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    issn = "0263-2136",
    publisher = "Oxford University Press",
    number = "2",

    }

    Economic evaluation of early administration of prednisolone and/or aciclovir for the treatment of Bell's palsy. / BELLS Trial Group.

    In: Family Practice, Vol. 26, No. 2, 04.2009, p. 137-144.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Economic evaluation of early administration of prednisolone and/or aciclovir for the treatment of Bell's palsy

    AU - Hernandez, R. A.

    AU - Sullivan, F.

    AU - Donnan, P.

    AU - Swan, I.

    AU - Vale, L.

    AU - BELLS Trial Group

    A2 - Smith, Blair

    PY - 2009/4

    Y1 - 2009/4

    N2 - Objectives. Bell's palsy (BP), which causes facial paralysis, affects 11–40 people per 100?000 per annum in the UK. Its cause is unknown but as many as 30% of patients have continuing facial disfigurement, psychological difficulties and occasionally facial pain. We present an randomised controlled trial (RCT)-based economic evaluation of the early administration of steroids (prednisolone) and/or antivirals (acyclovir) compared to placebo, for treatment of BP.Methods. The RCT was not powered to detect differences in the cost-effectiveness; therefore, we adopted a decision analytic model approach as a way of gaining precision in our cost-effectiveness comparisons [e.g. prednisolone only (PO) versus acyclovir only versus prednisolone and acyclovir versus placebo, prednisolone versus no prednisolone (NP) and acyclovir versus no acyclovir]. We assumed that trial interventions affect the probability of being cured/not cured but their consequences are independent of the initial therapy. We used the percentage of individuals with a complete recovery (based on House–Brackmann grade?=?1) at 9 months and Quality Adjusted Life Years (e.g. derived on responses to the Health Utilities Index III) as measures of effectiveness. Other parameter estimates were obtained from trial data.Results. PO dominated—i.e. was less costly and more effective—all other therapy strategies in the four arms model [77% probability of cost-effective (CE)]. Moreover, Prednisolone dominated NP (77% probability of being CE at £30?000 threshold) while no acyclovir dominated aciclovir (85% chance of CE), in the two arms models, respectively.Conclusions. Treatment of BP with prednisolone is likely to be considered CE while treatment with acyclovir is highly unlikely to be considered CE. Further data on costs and utilities would be useful to confirm findings.

    AB - Objectives. Bell's palsy (BP), which causes facial paralysis, affects 11–40 people per 100?000 per annum in the UK. Its cause is unknown but as many as 30% of patients have continuing facial disfigurement, psychological difficulties and occasionally facial pain. We present an randomised controlled trial (RCT)-based economic evaluation of the early administration of steroids (prednisolone) and/or antivirals (acyclovir) compared to placebo, for treatment of BP.Methods. The RCT was not powered to detect differences in the cost-effectiveness; therefore, we adopted a decision analytic model approach as a way of gaining precision in our cost-effectiveness comparisons [e.g. prednisolone only (PO) versus acyclovir only versus prednisolone and acyclovir versus placebo, prednisolone versus no prednisolone (NP) and acyclovir versus no acyclovir]. We assumed that trial interventions affect the probability of being cured/not cured but their consequences are independent of the initial therapy. We used the percentage of individuals with a complete recovery (based on House–Brackmann grade?=?1) at 9 months and Quality Adjusted Life Years (e.g. derived on responses to the Health Utilities Index III) as measures of effectiveness. Other parameter estimates were obtained from trial data.Results. PO dominated—i.e. was less costly and more effective—all other therapy strategies in the four arms model [77% probability of cost-effective (CE)]. Moreover, Prednisolone dominated NP (77% probability of being CE at £30?000 threshold) while no acyclovir dominated aciclovir (85% chance of CE), in the two arms models, respectively.Conclusions. Treatment of BP with prednisolone is likely to be considered CE while treatment with acyclovir is highly unlikely to be considered CE. Further data on costs and utilities would be useful to confirm findings.

    KW - Acyclovir

    KW - Bell's palsy

    KW - Cost-effectiveness analysis

    KW - Economic evaluation

    KW - Prednisolone

    U2 - 10.1093/fampra/cmn107

    DO - 10.1093/fampra/cmn107

    M3 - Article

    VL - 26

    SP - 137

    EP - 144

    JO - Family Practice

    JF - Family Practice

    SN - 0263-2136

    IS - 2

    ER -