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Rheumatology 2007 46(9):1495-1501; doi:10.1093/rheumatology/kem183
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© The Author 2007. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Randomized trial of two physiotherapy interventions for primary care back and neck pain patients: cost–effectiveness analysis

A. Manca, J. C. Dumville1, D. J. Torgerson1, J. A. Klaber Moffett2, M. P. Mooney2, D. A. Jackson2 and S. Eaton2

Centre for Health Economics, University of York, York YO10 5DD, 1Department of Health Sciences, University of York, York YO10 5DD and 2Institute of Rehabilitation, University of Hull, Hull HU3 2PG, UK.

Correspondence to: Dr Andrea Manca, Centre for Health Economics, Alcuin A Block, University of York, York YO10 5DD, UK. E-mail: am126{at}york.ac.uk


  Abstract

Objectives. To assess the cost-effectiveness of a brief physiotherapy pain management approach using cognitive-behavioural principles (Solution-Finding Approach) when compared with a commonly used traditional method of physical therapy (McKenzie Approach).

Methods. Economic evaluation conducted alongside a randomized trial. The study related incremental differences in costs and benefits associated with the Solution Finding and McKenzie approaches over 12 months. Costs were measured in UK pounds sterling. Benefit was measured as health-related quality of life using the EQ-5D, which was used to estimate patient-specific quality adjusted life years (QALYs).

Results. The McKenzie treatment required, on average, one extra physiotherapist visit (4.15 vs 3.10). Over a 12-month period, Solution Finding was associated with a lower per patient cost of £–24.4 (95% CI £–49.6 to £0.789). The mean difference in QALYs between the two groups was –0.020 (95% CI –0.057 to 0.017); favouring those receiving McKenzie. Relating incremental mean costs and QALYs gave an incremental cost effectiveness ratio of £1220 (–24.4/–0.020) suggesting the McKenzie treatment is cost effective.

Conclusions. Results suggest that the additional cost associated with the McKenzie treatment when compared with the Solution Finding Approach may be worth paying, given the additional benefit the approach seems more likely to provide. Further research is needed to assess the extent to which the difference in physiotherapy visits between the two strategies is generalizable to other treatment settings.

KEY WORDS: Neck and back pain, Primary care, Cost, Benefits, Physiotherapy

Submitted 28 March 2007; revised version accepted 7 June 2007.
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