Randomized trial of two physiotherapy interventions for primary care back and neck pain patients: cost–effectiveness analysis

• Published in: Rheumatology (Oxford, England) Vol. 46; no. 9; pp. 1495 - 1501
• Main Authors: Manca, A., Dumville, J. C., Torgerson, D. J., Klaber Moffett, J. A., Mooney, M. P., Jackson, D. A., Eaton, S.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.09.2007; Oxford Publishing Limited (England)
• Subjects: Adult; Aged; Back Pain - economics; Back Pain - rehabilitation; Back Pain - therapy; Benefits; Biological and medical sciences; Cognitive Therapy - economics; Cognitive Therapy - methods; Cost; Cost-Benefit Analysis; Diseases of the osteoarticular system; Diseases of the spine; England; Health Care Costs - statistics & numerical data; Health Resources - utilization; Humans; Medical sciences; Middle Aged; Neck and back pain; Neck Pain - economics; Neck Pain - rehabilitation; Neck Pain - therapy; Physical Therapy Modalities - economics; Physiotherapy; Primary care; Psychotherapy, Brief - economics; Psychotherapy, Brief - methods; Quality of Life; Quality-Adjusted Life Years; Severity of Illness Index; State Medicine - economics; Treatment Outcome; England; Benefits; Neck and back pain; Primary care; Cost; Physiotherapy; Human; Costs; Lumbar spine; Low back pain; Diseases of the osteoarticular system; Spine disease; Care; Quality of life; Pain; Treatment; Dorsalgia; Health economy; Rachialgia; Dorsal spine; Neck; Cost analysis; Public health
• ISSN: 1462-0324; 1462-0332
• DOI: 10.1093/rheumatology/kem183

Objectives. To assess the cost-effectiveness of a brief physiotherapy pain management approach using cognitive-behavioural principles (Solution-Finding Approach) when compared with a commonly used traditional method of physical therapy (McKenzie Approach). Methods. Economic evaluation conducted alongside a randomized trial. The study related incremental differences in costs and benefits associated with the Solution Finding and McKenzie approaches over 12 months. Costs were measured in UK pounds sterling. Benefit was measured as health-related quality of life using the EQ-5D, which was used to estimate patient-specific quality adjusted life years (QALYs). Results. The McKenzie treatment required, on average, one extra physiotherapist visit (4.15 vs 3.10). Over a 12-month period, Solution Finding was associated with a lower per patient cost of £−24.4 (95% CI £−49.6 to £0.789). The mean difference in QALYs between the two groups was −0.020 (95% CI −0.057 to 0.017); favouring those receiving McKenzie. Relating incremental mean costs and QALYs gave an incremental cost effectiveness ratio of £1220 (−24.4/−0.020) suggesting the McKenzie treatment is cost effective. Conclusions. Results suggest that the additional cost associated with the McKenzie treatment when compared with the Solution Finding Approach may be worth paying, given the additional benefit the approach seems more likely to provide. Further research is needed to assess the extent to which the difference in physiotherapy visits between the two strategies is generalizable to other treatment settings.