Cost-effectiveness of a graded exercise therapy program for patients with chronic shoulder complaints.
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.
Geraets
Jacques J X R
JJ
Maastricht University and Institute for Rehabilitation Research, The Netherlands. Jacques.geraets@planet.nl
Goossens
Mariëlle E J B
ME
de Bruijn
Camiel P C
CP
de Groot
Imelda J M
IJ
Köke
Albère J S
AJ
Pelt
Rob A G B
RA
Van der Heijden
Geert
G
Dinant
Geert-Jan
GJ
van den Heuvel
Wim J A
WJ