title: Economic evaluation of a behavioral-graded activity program compared to physical therapy for patients following lumbar disc surgery.
abstract: METHODS
  An economic evaluation was conducted alongside a randomized controlled trial.
  
  
  BACKGROUND
  Little is known about the effectiveness of cognitive-behavioral treatment options for patients following lumbar disc surgery. If the knowledge available was supported by an economic evaluation, the information could then be used to make recommendations for the implementation of cognitive-behavioral treatment in the routine of rehabilitation following lumbar disc surgery.
  
  
  OBJECTIVE
  To examine the cost-effectiveness of a behavioral-graded activity program, which is an operant treatment, compared to usual care as delivered by a physical therapist for patients following first-time lumbar disc surgery.
  
  
  METHODS
  For the economic evaluation, a societal viewpoint was applied. The primary outcome measures (measured at the 12-month follow-up) were global perceived effect and functional status. To evaluate the economic consequences of the treatments, direct health care and non-health care costs were considered, as well as indirect costs.
  
  
  RESULTS
  The clinical outcomes showed no relevant differences between behavioral-graded activity (n = 52) and UC (n = 53). Treatment costs were almost identical in the two intervention groups. The difference in direct health care costs was, although not statistically significant, 264 EURO [95% CI: -3-525] higher in behavioral-graded activity than in usual care per patient-year. It was mainly the excess cost of visiting the physiotherapist in the behavioral-graded activity group that accounted for this difference. The difference in direct non-health care costs, although not statistically significant, was 388 EURO [95% CI: -217; 992] lower in the usual care group due to unpaid help by friends or family. Consequently, although again not statistically significant, the total direct costs in behavioral-graded activity are 639 EURO [95% CI: -91; 1368] higher than in usual care. For the indirect costs, there was a statistically significant difference, behavioral-graded activity being more expensive. The sensitivity analysis showed that these results are fairly robust.
  
  
  CONCLUSIONS
  This study concludes that there are no differences between the two treatment conditions on any of the clinical outcome measures but that behavioral-graded activity is associated with higher costs. Consequently, there is no reason for the implementation of behavioral-graded activity as the standard treatment for patients following lumbar disc surgery.
authors.affiliation: Department of Epidemiology, Maastricht University, The Netherlands. r.ostelo@vumc.nl
authors.forename: Raymond W J G
authors.initials: RW
authors.lastname: Ostelo
authors.forename: Mariëlle E J B
authors.initials: ME
authors.lastname: Goossens
authors.forename: Henrica C W
authors.initials: HC
authors.lastname: de Vet
authors.forename: Piet A
authors.initials: PA
authors.lastname: van den Brandt
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000191:economics*; D003216:Conditioning, Operant; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D005102:Health Expenditures; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000191:economics / Q000534:rehabilitation / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D026741:Physical Therapy Modalities / Q000191:economics*; D020127:Recovery of Function; D012585:Sciatica / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome