title: Cost-effectiveness of a physiotherapist-led service for orthopaedic outpatients.
abstract: OBJECTIVE
  Non-surgical treatment can be effective for many musculoskeletal conditions. Improving access to these options may improve the efficiency of hospitals. The Orthopaedic Physiotherapy Screening Clinic and Multidisciplinary Service offers early comprehensive assessment and coordinated, patient-centred care within a multidisciplinary framework. Our aim was to assess its cost-effectiveness compared with usual orthopaedic care.
  
  
  METHODS
  A Markov model was constructed to estimate the quality-adjusted life years and health care costs from the perspective of health care payers for outpatients with low back, knee or shoulder conditions compared to usual orthopaedic care. Data were obtained from a retrospective chart review, administrative sources, literature and expert opinion. The time frame was five years and all costs were reported in 2011 $AUD.
  
  
  RESULTS
  Compared with usual orthopaedic care, the physiotherapist-led service costs an additional $495 per Quality Adjusted Life Year gained. The model remained cost-effective over a range of one-way sensitivity analyses.
  
  
  CONCLUSIONS
  The physiotherapist-led service is likely to be highly cost-effective. Determining the optimal mix of hospital orthopaedic outpatient services may require more advanced modeling techniques to be applied.
authors.affiliation: Senior Research Fellow, Centre for Applied Health Economics, Griffith Health Institute, Griffith University, Brisbane, Australia t.comans@griffith.edu.au.
authors.forename: Tracy
authors.initials: T
authors.lastname: Comans
authors.affiliation: Assistant Program Manager, Statewide Neurosurgical and Orthopaedic Physiotherapy Screening Clinic and Multi-disciplinary Service. Metro North Hospital and Health Service, Queensland, Australia.
authors.forename: Maree
authors.initials: M
authors.lastname: Raymer
authors.affiliation: Principal Research Fellow, Queensland Health (RBWH Physiotherapy Department/OPSC & MDS) and University of Queensland (NHMRC CCRE Spinal Pain, Injury and Health), Queensland, Australia.
authors.forename: Shaun
authors.initials: S
authors.lastname: O'Leary
authors.affiliation: Director of Physiotherapy Services and Program Manager, State wide Neurosurgical and Orthopaedic Physiotherapy Screening Clinic and Multidisciplinary Service; West Moreton Hospital and Health Service, Queensland, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Smith
authors.affiliation: Professor of Health Economics and Director of the Population and Social Health Research Program, Centre for Applied Health Economics, Griffith Health Institute, Griffith University, Queensland, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Scuffham
mesh_terms: D000553:Ambulatory Care / Q000191:economics* / Q000458:organization & administration; D003362:Cost-Benefit Analysis; D019091:Critical Pathways / Q000191:economics / Q000458:organization & administration; D006801:Humans; D008390:Markov Chains; D009985:Orthopedics / Q000191:economics* / Q000458:organization & administration; D026761:Physical Therapy Specialty / Q000191:economics* / Q000458:organization & administration; D019057:Quality-Adjusted Life Years
keywords: cost-effectiveness; economic evaluation; orthopaedics; physiotherapy