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An economic evaluation of three physiotherapy treatments for non-specific neck disorders alongside a randomized trial
Primary Care Musculoskeletal Research Centre, Primary Care Sciences and 1Centre for Health Planning and Management, Keele University, Staffordshire ST5 5BG, UK
Correspondence to: Dr Martyn Lewis, Senior Lecturer in Statistics, Primary Care Musculoskeletal Research Centre, Primary Care Sciences, Keele University, Staffordshire ST5 5BG, UK. E-mail: a.m.lewis{at}cphc.keele.ac.uk.
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Abstract |
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Objectives. 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 £105, £119 and £123 in the A&E, MT and PSWD groups, respectively. Mean societal costs were £373, £303 and £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.
KEY WORDS: Randomized clinical trial, Economic evaluation, Cost effectiveness, Cost utility, Neck pain, Physiotherapy
Submitted 6 December 2006;
revised version accepted 9 August 2007.
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