Structured physiotherapy including a work place intervention for patients with neck and/or back pain in primary care: an economic evaluation

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Abstract

A cluster-randomized controlled trial, WorkUp, was conducted for working-aged patients at risk of sick leave or on short-term sick leave due to acute/subacute neck and/or back pain in Sweden. The purpose of WorkUp was to facilitate participants to stay at work or in case of sick leave, return-to-work. The aim of this study was to study whether the WorkUp trial was cost-effective. Patients in the intervention and reference group received structured evidence-based physiotherapy, while patients in the intervention group also received a work place dialogue with the employer as an add-on. The participants, 352 in total, were recruited from 20 physiotherapeutic units in primary healthcare in southern Sweden. The economic evaluation was performed both from a healthcare and a societal perspective with a 12-month time frame with extensive univariate sensitivity analyses. Results were presented as incremental cost–effectiveness ratios (ICER) with outcomes measured as quality-adjusted life-years (QALY) and proportion working for at least 4 weeks in a row without reported sick leave at 12-month follow-up. From the healthcare perspective, the ICER was €23,606 (2013 price year) per QALY gain. From the societal perspective the intervention was dominating, i.e.. less costly and more effective than reference care. Bootstrap analysis showed that the probability of the intervention to be cost-effective at €50,000 willingness-to-pay per QALY was 85% from the societal perspective. Structured evidence-based physiotherapeutic care together with workplace dialogue is a cost-effective alternative from both a societal and a healthcare perspective for acute/subacute neck and/or back pain patients.

Trial registration ClinicalTrials.gov: NCT02609750.

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The online version of this article (10.1007/s10198-018-1003-1) contains supplementary material, which is available to authorized users.

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Most cited references 24

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The influence of gender and other patient characteristics on health care-seeking behaviour: a QUALICOPC study

Ashley Thompson, Yvonne Anisimowicz, Baukje Miedema … (2016)

Background Canadians’ health care-seeking behaviour for physical and mental health issues was examined using the international Quality and Cost of Primary Care (QUALICOPC) survey that was conducted in 2013 in Canada. Method This study used the cross-sectional Patient Experiences Survey collected from 7260 patients in 759 practices across 10 Canadian provinces as part of the QUALICOPC study. A Responsive Care Scale (RCS) was constructed to reflect the degree of health care-seeking behaviour across 11 health conditions. Using several patient characteristics as independent variables, four multiple regression analyses were conducted. Results Patients’ self-reports indicated that there were gender differences in health care-seeking behaviour, with women reporting they visited their primary care provider to a greater extent than did men for both physical and mental health concerns. Overall, patients were less likely to seek care for mental health concerns in comparison to physical health concerns. For both women and men, the results of the regressions indicated that age, illness prevention, trust in physicians and chronic conditions were important factors when explaining health care-seeking behaviours for mental health concerns. Conclusion This study confirms the gender differences in health care-seeking behaviour advances previous research by exploring in detail the variables predicting differences in health care-seeking behaviour for men and women. The variables were better predictors of health care-seeking behaviour in response to mental health concerns than physical health concerns, likely reflecting greater variation among those seeking mental health care. This study has implications for those working to improve barriers to health care access by identifying those more likely to engage in health care-seeking behaviours and the variables predicting health care-seeking. Consequently, those who are not accessing primary care can be targeted and policies can be developed and put in place to promote their health care-seeking behavior.

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Swedish experience-based value sets for EQ-5D health states

Kristina Burström, SUN SUN, Ulf-G Gerdtham … (2013)

Purpose To estimate Swedish experience-based value sets for EQ-5D health states using general population health survey data. Methods Approximately 45,000 individuals valued their current health status by means of time trade off (TTO) and visual analogue scale (VAS) methods and answered the EQ-5D questionnaire, making it possible to model the association between the experience-based TTO and VAS values and the EQ-5D dimensions and severity levels. The association between TTO and VAS values and the different severity levels of respondents’ answers on a self-rated health (SRH) question was assessed. Results Almost all dimensions (except usual activity) and severity levels had less impact on TTO valuations compared with the UK study based on hypothetical values. Anxiety/depression had the greatest impact on both TTO and VAS values. TTO and VAS values were consistently related to SRH. The inclusion of age, sex, education and socioeconomic group affected the main effect coefficients and the explanatory power modestly. Conclusions A value set for EQ-5D health states based on Swedish valuations has been lacking. Several authors have recently advocated the normative standpoint of using experience-based values. Guidelines of economic evaluation for reimbursement decisions in Sweden recommend the use of experience-based values for QALY calculations. Our results that anxiety/depression had the greatest impact on both TTO and VAS values underline the importance of mental health for individuals’ overall HRQoL. Using population surveys is in line with recent thinking on valuing health states and could reduce some of the focusing effects potentially appearing in hypothetical valuation studies. Electronic supplementary material The online version of this article (doi:10.1007/s11136-013-0496-4) contains supplementary material, which is available to authorized users.

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Confidence intervals or surfaces? Uncertainty on the cost-effectiveness plane.

P Fenn, Marc A. Briggs (1998)

Although cost-effectiveness analysis is not new, it is only recently that economic analysis has been conducted alongside clinical trials. Whereas in the past economic analysts most often used sensitivity analysis to examine the implications of uncertainty for their results, the existence of patient-level data on costs and effects opens up the possibility of statistical analysis of uncertainty. Unfortunately, ratio statistics can cause problems for standard statistical methods of confidence interval estimation. The recent health economics literature contains a number of suggestions for estimating confidence limits for ratios. In this paper, we begin by reviewing the different methods of confidence interval estimation with a view to providing guidance concerning the most appropriate method. We go on to argue that the focus on confidence interval estimation for cost-effectiveness ratios in the recent literature has been concerned more with problems of estimation than with problems of decision-making. We argue that decision-makers are most likely to be interested in one-sided tests of hypothesis and that confidence surfaces are better suited to such tests than confidence intervals. This approach is consistent with decision-making on the cost-effectiveness plane and with the cost-effectiveness acceptability curve approach to presenting uncertainty due to sampling variation in stochastic cost-effectiveness analyses.

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Author and article information

Contributors

Sanjib Saha: +46 76 648 66 66 , sanjib.saha@med.lu.se

Journal

Journal ID (nlm-ta): Eur J Health Econ

Journal ID (iso-abbrev): Eur J Health Econ

Title: The European Journal of Health Economics

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 1618-7598

ISSN (Electronic): 1618-7601

Publication date (Electronic): 31 August 2018

Publication date PMC-release: 31 August 2018

Publication date (Print): 2019

Volume: 20

Issue: 2

Pages: 317-327

Affiliations

[1 ]ISNI 0000 0001 0930 2361, GRID grid.4514.4, Health Economics Unit, Department of Clinical Science (Malmö), , Lund University, ; Medicon Village, Scheelevägen 2, 22381 Lund, Sweden

[2 ]ISNI 0000 0001 0930 2361, GRID grid.4514.4, Department of Clinical Sciences Lund, Orthopedics, , Lund University, ; Lund, Sweden

[3 ]Department of Research and Development, Region Kronoberg, Växjo, Sweden

[4 ]ISNI 0000 0001 0930 2361, GRID grid.4514.4, Centre for Economic Demography, , Lund University, ; Lund, Sweden

[5 ]ISNI 0000 0001 0930 2361, GRID grid.4514.4, Department of Economics, , Lund University, ; Lund, Sweden

[6 ]ISNI 0000 0001 0930 2361, GRID grid.4514.4, Department of Health Sciences, Physiotherapy, , Lund University, ; Lund, Sweden

[7 ]ISNI 0000 0004 0623 9987, GRID grid.411843.b, Skåne University Hospital, ; Lund, Sweden

[8 ]ISNI 0000 0001 0930 2361, GRID grid.4514.4, Division of Occupational and Environmental Medicine, Institute of Laboratory Medicine, , Lund University, ; Lund, Sweden

Article

Publisher ID: 1003

DOI: 10.1007/s10198-018-1003-1

PMC ID: 6438933

PubMed ID: 30171489

SO-VID: b1dceac8-4941-4480-9355-55a9fe8395a3

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Date received : 25 January 2018

Date accepted : 27 August 2018

Funding

Funded by: Blekinge county council

Funded by: Kronoberg and Skåne regional councils

Funded by: FundRef http://dx.doi.org/10.13039/100009107, Vårdalstiftelsen;

Award ID: REHSAM

Award ID: RF11-005

Award Recipient : Birgitta Grahn

Funded by: Government Grant for Clinical Research

Award ID: ALF

Award ID: Dnr F:2014/354

Award Recipient : Ulf-G. Gerdtham

Custom metadata

ScienceOpen disciplines: Economics of health & social care

Keywords: cost–effectiveness analysis,cost–utility analysis,return-to-work,musculoskeletal pain,quality-adjusted life-years,h43,i10,i18

Data availability:

ScienceOpen disciplines: Economics of health & social care

Keywords: cost–effectiveness analysis, cost–utility analysis, return-to-work, musculoskeletal pain, quality-adjusted life-years, h43, i10, i18

Structured physiotherapy including a work place intervention for patients with neck and/or back pain in primary care: an economic evaluation

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Most cited references 24

The influence of gender and other patient characteristics on health care-seeking behaviour: a QUALICOPC study

Swedish experience-based value sets for EQ-5D health states

Confidence intervals or surfaces? Uncertainty on the cost-effectiveness plane.

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