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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 UK pounds 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.

journal_name

Fam Pract

journal_title

Family practice

authors

Hernández RA,Sullivan F,Donnan P,Swan I,Vale L,BELLS Trial Group.

doi

10.1093/fampra/cmn107

subject

Has Abstract

pub_date

2009-04-01 00:00:00

pages

137-44

issue

eissn

0263-2136

issn

1460-2229

pii

cmn107

journal_volume

pub_type

杂志文章,多中心研究,随机对照试验

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