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- Landén Ludvigsson, Maria, 1967-, et al.
(författare)
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Cost-effectiveness of neck-specific exercise with or without a behavioral approach versus physical activity prescription in the treatment of chronic whiplash-associated disorders : Analyses of a randomized clinical trial
- 2017
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Ingår i: Medicine. - : LIPPINCOTT WILLIAMS & WILKINS. - 0025-7974 .- 1536-5964. ; 96:25
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Tidskriftsartikel (refereegranskat)abstract
- Background: Fifty percent of people injured by whiplash still report neck pain after 1 year and costs associated with whiplash associated disorders (WAD) are mostly attributed to health service and sick-leave costs in chronic conditions. With increasing health care expenditures the economic impact of interventions needs to be considered.Objective: To analyze the cost-effectiveness of physiotherapist-led neck-specific exercise without (NSE) or with a behavioral approach (NSEB), or prescription of physical activity (PPA) in chronic WAD, grade 2 to 3.Methods: This is a secondary cost-effectiveness analysis of a multicenter randomized clinical trial of 216 participants with chronic WAD grade 2 to 3. The interventions were physiotherapist-led neck-specific exercise without or with a behavioral approach, or prescription of physical activity for 12 weeks. Incremental cost-effectiveness ratios (ICERs) were determined after 1 year and bootstrapped cost-effectiveness planes and sensitivity analyses of physiotherapy visits were performed. Health care and production loss costs were included and quality-adjusted life years (QALYs) were estimated, using the Euroqol-5D questionnaire. Comparisons with the Short Form-6D, and neck disability index (NDI) were also made.Results: The 1-year follow-up was completed by 170 participants (79%). Both physiotherapist-led groups improved in health related quality of life. The intervention cost alone, per quality-adjusted life year (QALY) gain in the NSE group was US$12,067. A trend for higher QALY gains were observed in the NSEB group but the costs were also higher. The ICERs varied depending on questionnaire used, but the addition of a behavioral approach to neck-specific exercise alone was not cost-effective from a societal perspective (ICER primary outcome $127,800 [95% confidence interval [CI], 37,816-711,302]). The sensitivity analyses confirmed the results. The prescription of physical activity did not result in any QALY gain and the societal costs were not lower.Conclusion: Neck-specific exercise was cost-effective from a societal perspective in the treatment of chronic WAD compared with the other exercise interventions. ICERS varied depending on health-related quality of life questionnaires used, but the addition of a behavioral approach was not cost-effective from a societal perspective. The prescription of physical activity did not result in any QALY gain and was thus not considered a relevant option.
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| 2. |
- Peolsson, Anneli, et al.
(författare)
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Neck-specific exercises with internet-based support compared to neck-specific exercises at a physiotherapy clinic for chronic whiplash-associated disorders : study protocol of a randomized controlled multicentre trial.
- 2017
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 18
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Tidskriftsartikel (refereegranskat)abstract
- Background:Globally, neck pain is the fourth most common condition associated with longer periods of living withdisability. Annually, approximately 0.3% of the population of Western countries undergo whiplash trauma, and half ofthose individuals will develop chronic problems with highcosts for the individual and society. Evidence for chronicwhiplash-associated disorders (WAD) treatment is scarce, though neck-specific training at a physiotherapy clinic twice aweek for 12 weeks has demonstrated good results. More efficient, flexible rehabilitation with reduced waiting times andlower costs is needed, ideally replacing lengthy on-site treatment series by healthcare providers. Internet-based care hasbeen shown to be a viable alternative for a variety of diseases and interventions, but studies are lacking on Internet-basedinterventions for individuals with chronic neck problems. The aim of the trial described here is to compare the effects ofan Internet-based neck-specific exerciseprogrammetothesameexercisesperformed at a physiotherapy clinic in regardsto self-reported and clinical measures, as well as cost-effectiveness.Methods:This prospective, randomized controlled trial will involve 140 participants. Measurements will be made atbaseline, 3 months (end of treatment), and 15 months (12 months after end of intervention) and will include ratings ofpain, disability, satisfaction with care, work ability, quality of life, and cost-effectiveness.Discussion:The study results may contribute to the development of a more effective rehabilitation, flexible and equalcare, shorter waiting times, increased availability, and lower costs for healthcare and society.Trial registration:ClinicalTrials.gov Protocol ID: NCT03022812, initial release 12/20/2016.
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