Cost-effectiveness evaluation of an RCT in rehabilitation after lumbar spinal fusion: a low-cost, behavioural approach is cost-effective over individual exercise therapy.
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.
Søgaard
Rikke
R
Orthopaedic Research Laboratory, University Hospital of Aarhus, Norrebrogade 44, 8000, Aarhus, Denmark. rikke.sogaard@ki.au.dk
Bünger
Cody E
CE
Laurberg
Ida
I
Christensen
Finn B
FB
D000328:Adult; D001521:Behavior Therapy / Q000191:economics*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D004185:Disability Evaluation; D005081:Exercise Therapy / Q000191:economics*; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D016032:Randomized Controlled Trials as Topic; D013123:Spinal Fusion / Q000534:rehabilitation*; D016896:Treatment Outcome
Spine (Phila Pa 1976). 2003 Feb 1;28(3):209-18
12567020
Eur Spine J. 2007 May;16(5):657-68
16871387
Spine (Phila Pa 1976). 2004 Feb 15;29(4):421-34; discussion Z3
15094539
Am J Public Health Nations Health. 1967 Nov;57(11):1954-66
6069745
Spine (Phila Pa 1976). 1989 May;14(5):511-6
2524890
Pain. 1994 Jun;57(3):317-26
7936710
Ugeskr Laeger. 1995 Jun 26;157(26):3741-5
7631448
J Health Econ. 1995 Jun;14(2):171-89
10154656
Dan Med Bull. 1997 Sep;44(4):445-8
9377907
Dan Med Bull. 1997 Sep;44(4):449-53
9377908
Dan Med Bull. 1997 Nov;44(5):542-6
9408740
Spine (Phila Pa 1976). 1997 Dec 15;22(24):2807-12
9431616
Spine (Phila Pa 1976). 1997 Dec 15;22(24):2813-22
9431617
Health Econ. 1998 Feb;7(1):39-51
9541083
J Health Econ. 1999 Jun;18(3):341-64
10537899
Spine J. 2005 Jan-Feb;5(1):36-44
15653083
BMJ. 2005 May 28;330(7502):1239
15911536
Spine (Phila Pa 1976). 2000 Jul 1;25(13):1711-5
10870148
Spine (Phila Pa 1976). 2000 Jul 1;25(13):1716-21
10870149
Spine (Phila Pa 1976). 2001 Dec 1;26(23):2521-32; discussion 2532-4
11725230
Spine (Phila Pa 1976). 2002 May 1;27(9):901-9; discussion 909-10
11979157
Spine (Phila Pa 1976). 2002 Jun 1;27(11):1131-41
12045508
Spine (Phila Pa 1976). 2002 Jun 15;27(12):1269-77
12065973
Spine (Phila Pa 1976). 2002 Dec 1;27(23):2674-83
12461393
BMJ. 2005 May 28;330(7502):1233
15911537
Eur Spine J. 2006 May;15(5):648-56
15937676
Spine (Phila Pa 1976). 2003 Dec 1;28(23):2561-9
14652472