Chelsea — close to South Kensington tube station and a number of popular bus routes through South West London. There is also meter parking directly outside the clinic. Complete Injections prices competitively to provide affordable ultrasound guided injections for pain relief.
We also offer ultrasound guided injection of hyaluronic acid. We have two products: Ostenil Plus 40mg in 2ml recommended for smaller joints e. Complete Injections keep prices affordable by offering a one-stop-shop assessment and treatment clinic. Many providers of injections may require you first to attend for an assessment, then send you for a scan and then review you before oftentimes being sent to yet another appointment in order to receive the injection. Also, key to this is that the patient may have as many as three or four people involved in their care.
Complete Injections has developed a unique one-stop-shop pathway whereby you are assessed, scanned, reviewed and injected by a single clinician within a single appointment. This saves time and money and allows us to provide a first class and efficient service at a highly competitive rate. Read our patient information page on advantages of ultrasound guided cortisone injections vs blind injections.
If you require any further information about ultrasound guided injections at Complete Injections, please do not hesitate to contact us on injections complete-physio. How much do steroid injections cost privately? View Larger Image. How much does a steroid injection cost privately in the U.
Why are prices at Complete Injections lower than at other clinics? The trial treatment resource use for the injection group was obtained from a retrospective GP record review of all available data. The data were searched for records of the trial injections in the 6-week treatment period following the known date of randomization to the trial. Attendance at a GP practice for injection was assumed to be a minor surgery attendance. If the injection took place at the hospital, a standard out-patient visit was assumed.
An extended review of all available GP records was used to determine co-interventions received for shoulder pain during the 6-month post-randomization period. Hence additional elements such as manipulation under anaesthetic, out-patient referrals for orthopaedic or rheumatology appointments, X-rays or additional visits to the GP associated with shoulder pain were recorded. Monetary costs were attached to each of the natural units. The resources were valued using a combination of local and national data.
Table 1 shows the resource components and their sources. Capital cost was apportioned as a percentage of all salaries and time, and taken from standard national figures [ 6 ]. Physiotherapy costs were assigned on a sessional basis. The cost of the injection at a GP surgery was assumed to be the cost of a normal GP session, plus an additional minor surgical fee for administering the injection, plus the cost of the injected drug [ 7 ].
The cost of the injection in hospital is that of a standard rheumatology out-patient visit [ 8 ] plus the cost of the drug. A base case analysis was presented on the pre position regarding the payment of minor surgical fees to GPs [ 9 ]. The primary outcome measure in the trial was shoulder disability at 6 months measured using a shoulder disability questionnaire previously validated for use in primary care [ 10 ]. Each measure of outcome used was designed to capture a different dimension of health-related quality of life.
The shoulder disability score is a questionnaire with the range of 0 to 23; where 23 indicates severe disability. The EQ5D is a multidimensional measure of health outcome producing an index with 1 being perfect health, 0 dead or unconscious, and the worst health state valued at —0. Pain severity and impairment of function were measured on a point numerical rating scale. Average total costs were calculated for patients in each treatment group. Given that cost data are often positively skewed, the non-parametric bootstrap was used to obtain confidence intervals for the mean differences in cost [ 13 ].
Bootstrapping is a resampling procedure: independent samples were generated for each treatment group by sampling with replacement from the study data, with each bootstrap sample being the same size as the original sample. Bootstrapping was performed using Stata statistical software. The role of a sensitivity analysis is to test whether changes in key variables will change the results obtained from the base case analysis.
In the base case analysis, assumptions had been made regarding GP caseload and the minor surgical fee assigned, and it was felt appropriate to test the effect of these assumptions. The sensitivity analysis was performed around both these variables. Two scenarios were chosen for analysis.
Two hundred and thirty-seven subjects were registered for the trial, of whom were randomized— to receive physiotherapy and to injection. Eight sets of GP notes were not reviewed for the following reasons: four patients had moved, two refused, one was deceased and one set was missing. The analysis presented is therefore on subjects.
A cost consequences analysis was performed to take into account the broad range of outcomes and costs. Average resource use per patient for both arms of the trial is shown in Table 2. The related costs are shown in Table 3. It can be seen from these findings that the treatment of choice in terms of the economic argument is treatment of shoulder pain by injection.
Costs are split into the active treatment period and the follow-up period, that is those attributable to the treatment alone and those to subsequent care. These are presented in Table 4. Although follow-up costs were greater for injection than for physiotherapy, they do not outweigh the intervention costs for trial physiotherapy.
Table 5 shows the results at 6 months across all the different outcome measures, previously presented in Hay et al. It can be seen from Table 5 that for each outcome, the results are broadly similar across the two groups with no significant difference between the treatment groups in the primary or secondary outcome measures.
Sensitivity analyses were performed on the two scenarios presented in the methods. Table 6 shows the results of these analyses. It can be seen that the gap between injection costs and physiotherapy costs narrows in each scenario. In terms of costs in scenario one—low volume—the cost difference remains significant.
In option two—new fee—the cost difference is not significant. This cost consequences analysis of a randomized clinical trial comparing local steroid injection and physiotherapy for treating new episodes of unilateral shoulder pain has shown a statistically significant difference in treatment costs in favour of injections.
Given the similar outcomes seen in the two treatment groups, and the significant difference in costs, the reporting and discussion of costing results will therefore be of primary importance in the treatment choice of physiotherapy versus injection in shoulder pain for a health-care decision-maker.
This study has shown that corticosteroid injections are the cost-effective option for patients presenting with new episodes of unilateral shoulder pain in this randomized clinical trial. Given a fixed budget and limited resources, more patients could be treated by a GP using injection therapy than physiotherapy up to eight sessions. In real terms, the opportunity cost of two physiotherapy courses is just over three injections, that is with the same funds either two physiotherapy courses could be funded or three courses of injection.
The study used direct identification and presentation of the resources used in each intervention. Presentation of the findings in this manner enables local decision-makers to apply the results of the study to their own setting and impute local cost figures as deemed appropriate.
A major contributor to the resources required for an intervention is staffing. Costs attributable to staff, quantified by the hourly wage rate and the amount of staff time consumed or attributable to each intervention, were large cost drivers in this study. In the interventions reported here, although GPs earn a higher hourly wage rate than physiotherapists, it is the actual amount of staff time that is the key cost driver.
In this study, physiotherapy was highly intensive of staff time in terms of the length of sessions and the frequency of attendance. Patients had, on average, six min sessions, i. While a GP's time is more expensive, the time involved in patient contact is shorter as injections were usually given in a single, short GP appointment.
Although there are additional drug costs for injections, these factors did not outweigh the much greater time input given by the physiotherapist and hence the costs of treatment were greater for physiotherapy. We found that the injection group had slightly more GP post-intervention visits than the physiotherapy group. However, the greater frequency of contact with more costly GP time did not outweigh the initial physiotherapy contact, and hence financially did not outweigh the benefits of injection over physiotherapy in this trial.
In this study, primary and secondary care resource use and costs have been included for 6-months post-randomization. If a wider viewpoint were considered that also included patient costs, it is likely that there would be an even greater difference in costs between the groups. For injections, patients usually attended their GP practice once for a short appointment; while patients receiving physiotherapy made repeated visits for min sessions hence incurring greater travel costs.
Physiotherapy is time-consuming for patients in terms of time off work or away from usual activities, hence the treatment itself imposes a greater impact on society. The economic findings do not take into account other factors which may affect choice of treatment, including patient preferences. We have previously shown that patient preference was associated with outcome and that future treatment preference was affected by previous clinical outcome [ 16 ].
Patients may prefer to receive a course of physiotherapy rather than an injection. It is possible that as the physiotherapy group had more professional contact time they were more able to express any worries and concerns throughout their treatment and hence felt less need to visit their GP once treatment had ended. This may explain the lower rate of GP visits in the follow-up period in the physiotherapy group. This study is the first to address an economic evaluation of physiotherapy and injections for shoulder pain in a primary care setting.
The presented results are supported by those of a secondary-care-based study which showed similarities in clinical outcomes between treatment groups, but substantial differences in costs, in line with the present findings [ 17 ]. Caution, however, should be attached to directly comparing these results with those reported in that paper as vital information such as the duration of time allocated to administer the injection and the number of sessions of physiotherapy received was not reported in the earlier study.
It can be seen from the sensitivity analysis that the more expensive the GP minor surgical fee the less the cost advantage for injection. Who administers corticosteroid injection is something that merits further discussion. Injection therapy has been within the remit of physiotherapists since [ 18 ] and its addition to the key core skills in the physiotherapist role may reduce the cost associated with injections when compared with those incurred when injections are administered by GPs.
This study has shown that corticosteroid injections are a cost-effective option for patients presenting with new episodes of unilateral shoulder pain. The cost difference between the two treatment arms was statistically significant in the base case analysis. The introduction of a GP minor surgical fee per injection reduces the strength of these findings and statistical significance is lost.
The results in terms of cost and effects are still in favour of injection over physiotherapy. With a limited budget it is therefore possible to treat more patients with injections than with a course of community-based physiotherapy.
We thank the GPs, the staff, the physiotherapists and the participants involved in the trial. A pragmatic randomised controlled trial of local corticosteroid injection and physiotherapy for the treatment of new episodes of unilateral shoulder pain in primary care. Ann Rheum Dis ; 62 : —9. Croft P. Soft tissue rheumatism. Epidemiology of the rheumatic diseases. Oxford: Oxford Medical Publications, : — Shoulder disorders in general practice: incidence, patient characteristics and management.
Ann Rheum Dis ; 54 : — The death of cost minimization. Health Econ ; 10 : — Virtual outreach: economic evaluation of joint teleconsultations for patients referred by their general practitioner for a specialist opinion. Br Med J ; : 84 — Unit costs of health and social care British National Formulary NHS Executive. National Schedule of Reference Costs, Leeds: NHS Executive, Measurement of shoulder related disability: results of a validation study.
Ann Rheum Dis ; 53 : —8. EQ-5D: an overview. EuroQol Group Newsletter including survey of usage. Efficacy of traction for non-specific low back pain: a randomised clinical trial. Lancet ; : — Thompson S, Barber J.
How should cost data in pragmatic randomised trials be analysed? Br Med J ; : — Pulling cost-effectiveness analysis up by its bootstraps: non-parametric approach to confidence interval estimation. Health Econ ; 6 : — NHS Confederation. Investing in general practice: the new general medical services contract.
London: NHS Confederation, Results from a primary care-based randomised trial for shoulder pain. Br J Gen Pract ; 54 : 93 —6. Injections and physiotherapy for the painful stiff shoulder. Ann Rheum Dis ; 48 : —5. Mullion C.
Profession still divided on injection therapy. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account.
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|The best steroid to take||Sign In. The costs of the injections vary, cindy landolt steroids on the amount used, the area to which the shot is administered, and the condition it is used to treat. This was a pragmatic study, and after the 6-week assessment GPs were at liberty to prescribe other treatments if clinically indicated. Frozen shoulder is a common condition resulting in pain, stiffness and functional impairment. Basic cortisone shots such as acne treatment basically involve cleaning the area prior to injecting to make sure it is disinfected thereby reducing the risk of being infected further.|
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