title: Cost-effectiveness of a graded exercise therapy program for patients with chronic shoulder complaints.
abstract: OBJECTIVE
  The present study evaluated the cost-effectiveness of a behavioral graded exercise therapy (GET) program compared with usual care (UC) in terms of the performance of daily activities by patients with chronic shoulder complaints in primary care.
  
  
  METHODS
  A total of 176 patients were randomly assigned either to GET (n=87) or to UC (n=89). Clinical outcomes (main complaints, shoulder disability [SDQ] and generic health-related quality of life [EQ-5D], and costs [intervention costs, direct health care costs, direct non-health-related costs, and indirect costs]) were assessed during the 12-week treatment period and at 52 weeks of follow-up.
  
  
  RESULTS
  Results showed that GET was more effective than UC in restoring daily activities as assessed by the main complaints instrument after the 12-week treatment period (p = .049; mean difference, 7.5; confidence interval [CI], 0.0-15.0). These effects lasted for at least 52 weeks (p = .025; mean difference 9.2; CI, 1.2-17.3). No statistically significant differences were found on the SDQ or EQ5D. GET significantly reduced direct health care costs (p = .000) and direct non-health care costs (p = .029). Nevertheless, total costs during the 1-year follow-up period were significantly higher (p = .001; GET = Euro 530 versus UC = Euro 377) due to the higher costs of the intervention. Incremental cost-effectiveness ratios for the main complaints (0-100), SDQ (0-100), and EQ-5D (-1.0-1.0) were Euro 7, Euro 74, and Euro 5278 per unit of improvement, respectively.
  
  
  CONCLUSIONS
  GET proved to be more effective in the short- and long-term and reduces direct health care costs and direct non-health care costs but is associated with higher costs of the intervention itself.
authors: Maastricht University and Institute for Rehabilitation Research, The Netherlands. Jacques.geraets@planet.nl
authors: Jacques J X R
authors: JJ
authors: Geraets
authors: Mariëlle E J B
authors: ME
authors: Goossens
authors: Camiel P C
authors: CP
authors: de Bruijn
authors: Imelda J M
authors: IJ
authors: de Groot
authors: Albère J S
authors: AJ
authors: Köke
authors: Rob A G B
authors: RA
authors: Pelt
authors: Geert
authors: G
authors: Van der Heijden
authors: Geert-Jan
authors: GJ
authors: Dinant
authors: Wim J A
authors: WJ
authors: van den Heuvel