An economic evaluation of three physiotherapy treatments for non-specific neck disorders alongside a randomized trial.
OBJECTIVE
Cost-effectiveness and cost-utility analyses were conducted to compare advice and exercise plus manual therapy (MT) and advice and exercise plus pulsed shortwave diathermy (PSWD) with advice and exercise alone (A&E) in the treatment of non-specific neck disorders by experienced physiotherapists.


METHODS
Between July 2000 and June 2002, 350 participants with neck disorders from 15 physiotherapy departments were randomized to: A&E (n = 115); MT (n = 114) and PSWD (n = 121). Outcome and resource-use data were collected using physiotherapist case report forms and participant self-complete questionnaires. Outcome measures were the Northwick Park Neck Pain Questionnaire (NPQ) and EuroQoL EQ-5D [used to derive quality-adjusted-life-year (QALY) utility scores]. Two economic viewpoints were considered (health care and societal). Cost-effectiveness acceptability curves were used to assess the probabilities of the interventions being cost-effective at different willingness-to-pay threshold values.


RESULTS
Mean improvement in NPQ at 6 months was 11.5 in the A&E group, 10.2 in the MT group and 10.3 in the PSWD group; mean QALY scores were 0.362, 0.342 and 0.360, respectively. Mean health care costs were pound sterling105, pound sterling119 and pound sterling123 in the A&E, MT and PSWD groups, respectively. Mean societal costs were pound sterling373, pound sterling303 and pound sterling 338 in each group, respectively. Depending on the viewpoint and the outcome measure, A&E or MT were most likely to be the cost-effective interventions. PSWD was consistently the least cost-effective intervention.


CONCLUSIONS
The cost-effective intervention is likely to be A&E or MT, depending on the economic perspective and preferred outcome, but not PSWD.
Lewis
M
M
Primary Care Musculoskeletal Research Centre, Primary Care Sciences, Keele University, Staffordshire ST5 5BG, UK. a.m.lewis@cphc.keele.ac.uk
James
M
M
Stokes
E
E
Hill
J
J
Sim
J
J
Hay
E
E
Dziedzic
K
K
D000328:Adult; D001294:Attitude to Health; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D003972:Diathermy / Q000191:economics; D004739:England; D005081:Exercise Therapy / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000191:economics* / Q000534:rehabilitation*; D010147:Pain Measurement / Q000379:methods; D010353:Patient Education as Topic / Q000191:economics; D026741:Physical Therapy Modalities / Q000191:economics*; D019057:Quality-Adjusted Life Years; D018434:Sickness Impact Profile; D016896:Treatment Outcome