Cost-effectiveness evaluation of an RCT in rehabilitation after lumbar spinal fusion: A low-cost, behavioural approach is cost-effective over individual exercise therapy

Rikke Søgaard, Cody E Bünger, Ida Laurberg, Finn B Christensen

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

Udgivelsesdato: 2008-Feb
OriginalsprogEngelsk
TidsskriftEuropean Spine Journal
Vol/bind17
Udgave nummer2
Sider (fra-til)262-271
Antal sider9
ISSN0940-6719
DOI
StatusUdgivet - 1. feb. 2008

Fingeraftryk

Cost-Benefit Analysis
Health Care Sector
Return to Work
Physical Therapists
Low Back Pain
Primary Health Care
Pathology
Health

Citer dette

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title = "Cost-effectiveness evaluation of an RCT in rehabilitation after lumbar spinal fusion: A low-cost, behavioural approach is cost-effective over individual exercise therapy",
abstract = "Recently, Christensen et al. reported the clinical effects of a low-cost rehabilitation program equally efficient to a relatively intensive program of individual, physiotherapist-guided exercise therapy. Yet, the low-cost approach is not fully supported as an optimal strategy until a full-scale economic evaluation, including extra-hospital effects such as service utilization in the primary health care sector and return-to-work, is conducted. The objective of this study was to conduct such evaluation i.e. investigate the cost-effectiveness of (1) a low-cost rehabilitation regimen with a behavioural element and (2) a regimen of individual exercise therapy, both in comparison with usual practice, from a health economic, societal perspective. Study design was a cost-effectiveness evaluation of an RCT with a 2-year follow-up. Ninety patients having had posterolateral or circumferential fusion (indicated by chronic low back pain and localized pathology) were randomized 3 months after their spinal fusion. Validated pain- and disability index scales were applied at baseline and at 2 years postoperative. Costs were measured in a full-scale societal perspective. The probability of the behavioural approach being cost-effective was close to 1 given pain as the prioritized effect measure, and 0.8 to 0.6 (dependent on willingness to pay per effect unit) given disability as the prioritized effect measure. The probability of the exercise therapy approach being cost-effective was modest due to inferior effectiveness. Results proved robust to relevant sensitivity analysis although a differentiated cost-effectiveness ratio between males and females was suspected. In conclusion, a simple behavioural extension, of setting up group meetings for patients, to a regimen with a strict physiotherapeutic focus was found cost-effective, whereas the cost-effectiveness of increasing frequency and guidance of a traditional physiotherapeutic regimen was unlikely in present trial setting.",
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author = "Rikke S{\o}gaard and B{\"u}nger, {Cody E} and Ida Laurberg and Christensen, {Finn B}",
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Cost-effectiveness evaluation of an RCT in rehabilitation after lumbar spinal fusion : A low-cost, behavioural approach is cost-effective over individual exercise therapy. / Søgaard, Rikke; Bünger, Cody E; Laurberg, Ida; Christensen, Finn B.

I: European Spine Journal, Bind 17, Nr. 2, 01.02.2008, s. 262-271.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Cost-effectiveness evaluation of an RCT in rehabilitation after lumbar spinal fusion

T2 - A low-cost, behavioural approach is cost-effective over individual exercise therapy

AU - Søgaard, Rikke

AU - Bünger, Cody E

AU - Laurberg, Ida

AU - Christensen, Finn B

PY - 2008/2/1

Y1 - 2008/2/1

N2 - Recently, Christensen et al. reported the clinical effects of a low-cost rehabilitation program equally efficient to a relatively intensive program of individual, physiotherapist-guided exercise therapy. Yet, the low-cost approach is not fully supported as an optimal strategy until a full-scale economic evaluation, including extra-hospital effects such as service utilization in the primary health care sector and return-to-work, is conducted. The objective of this study was to conduct such evaluation i.e. investigate the cost-effectiveness of (1) a low-cost rehabilitation regimen with a behavioural element and (2) a regimen of individual exercise therapy, both in comparison with usual practice, from a health economic, societal perspective. Study design was a cost-effectiveness evaluation of an RCT with a 2-year follow-up. Ninety patients having had posterolateral or circumferential fusion (indicated by chronic low back pain and localized pathology) were randomized 3 months after their spinal fusion. Validated pain- and disability index scales were applied at baseline and at 2 years postoperative. Costs were measured in a full-scale societal perspective. The probability of the behavioural approach being cost-effective was close to 1 given pain as the prioritized effect measure, and 0.8 to 0.6 (dependent on willingness to pay per effect unit) given disability as the prioritized effect measure. The probability of the exercise therapy approach being cost-effective was modest due to inferior effectiveness. Results proved robust to relevant sensitivity analysis although a differentiated cost-effectiveness ratio between males and females was suspected. In conclusion, a simple behavioural extension, of setting up group meetings for patients, to a regimen with a strict physiotherapeutic focus was found cost-effective, whereas the cost-effectiveness of increasing frequency and guidance of a traditional physiotherapeutic regimen was unlikely in present trial setting.

AB - Recently, Christensen et al. reported the clinical effects of a low-cost rehabilitation program equally efficient to a relatively intensive program of individual, physiotherapist-guided exercise therapy. Yet, the low-cost approach is not fully supported as an optimal strategy until a full-scale economic evaluation, including extra-hospital effects such as service utilization in the primary health care sector and return-to-work, is conducted. The objective of this study was to conduct such evaluation i.e. investigate the cost-effectiveness of (1) a low-cost rehabilitation regimen with a behavioural element and (2) a regimen of individual exercise therapy, both in comparison with usual practice, from a health economic, societal perspective. Study design was a cost-effectiveness evaluation of an RCT with a 2-year follow-up. Ninety patients having had posterolateral or circumferential fusion (indicated by chronic low back pain and localized pathology) were randomized 3 months after their spinal fusion. Validated pain- and disability index scales were applied at baseline and at 2 years postoperative. Costs were measured in a full-scale societal perspective. The probability of the behavioural approach being cost-effective was close to 1 given pain as the prioritized effect measure, and 0.8 to 0.6 (dependent on willingness to pay per effect unit) given disability as the prioritized effect measure. The probability of the exercise therapy approach being cost-effective was modest due to inferior effectiveness. Results proved robust to relevant sensitivity analysis although a differentiated cost-effectiveness ratio between males and females was suspected. In conclusion, a simple behavioural extension, of setting up group meetings for patients, to a regimen with a strict physiotherapeutic focus was found cost-effective, whereas the cost-effectiveness of increasing frequency and guidance of a traditional physiotherapeutic regimen was unlikely in present trial setting.

KW - Adult

KW - Behavior Therapy

KW - Cohort Studies

KW - Cost-Benefit Analysis

KW - Disability Evaluation

KW - Exercise Therapy

KW - Female

KW - Follow-Up Studies

KW - Health Care Costs

KW - Humans

KW - Lumbar Vertebrae

KW - Male

KW - Middle Aged

KW - Pain Measurement

KW - Randomized Controlled Trials as Topic

KW - Spinal Fusion

KW - Treatment Outcome

U2 - 10.1007/s00586-007-0479-7

DO - 10.1007/s00586-007-0479-7

M3 - Journal article

C2 - 17713794

VL - 17

SP - 262

EP - 271

JO - European Spine Journal

JF - European Spine Journal

SN - 0940-6719

IS - 2

ER -