Individualized Physical Therapy Is Cost-Effective Compared With Guideline-Based Advice for People With Low Back Disorders. Issue 3 (February 2017)

• Record Type: Journal Article
• Authors: Hahne, Andrew J.; Ford, Jon J.; Surkitt, Luke D.; Richards, Matthew C.; Chan, Alexander Y.P.; Slater, Sarah L.; Taylor, Nicholas F.
• Is Part Of: Spine. Volume 42:Issue 3(2017)
• Publication Date: 2017-02
• Subjects: cost-utility -- economic evaluation -- low back pain -- physical therapy; Spine -- Abnormalities -- Periodicals; Spine -- Diseases -- Periodicals; Spine -- Surgery -- Periodicals; 616.73005
• DOI: 10.1097/BRS.0000000000001734
• Languages: English
• ISSNs: 0362-2436

Abstract

Abstract : Study Design: A cost-utility analysis within a randomized controlled trial was conducted from the health care perspective. Objective: The aim of this study was to determine whether individualized physical therapy incorporating advice is cost-effective relative to guideline-based advice alone for people with low back pain and/or referred leg pain (≥6 weeks, ⩽6 months duration of symptoms). Summary of Background Data: Low back disorders are a burdensome and costly condition across the world. Cost-effective treatments are needed to address the global burden attributable to this condition. Methods: Three hundred participants were randomly allocated to receive either two sessions of guideline-based advice alone (n = 144), or 10 sessions of individualized physical therapy targeting pathoanatomical, psychosocial and neurophysiological factors, and incorporating advice (n = 156). Data relating to health care costs, health benefits (EuroQol-5D) and work absence were obtained from participants via questionnaires at 5, 10, 26, and 52-week follow-ups. Results: Total health care costs were similar for both groups: mean difference $27.03 [95% confidence interval (95% CI): -200.29 to 254.35]. Health benefits across the 12-month follow-up were significantly greater with individualized physical therapy: incremental quality-adjusted life years = 0.06 (95% CI: 0.02–0.10). The incremental cost-effectiveness ratio was $422 per quality-adjusted life year gained. The probability that individualized physical therapy was cost-effective reached 90% at a willingness-to-pay threshold of $36, 000. A saving of $1995.51 (95% CI: 143.98–3847.03) per worker in income was realized in the individualized physical therapy group relative to the advice group. Sensitivity and subgroup analyses all revealed a dominant position for individualized physical therapy; hence, the base case analysis was the most conservative. Conclusion: Ten sessions of individualized physical therapy incorporating advice is cost-effective compared with two sessions of guideline-based advice alone for people with low back disorders. Level of Evidence: 2