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

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Landén Ludvigsson, Maria,1967-Linköpings universitet,Avdelningen för fysioterapi,Medicinska fakulteten,Region Östergötland, Rehab Väst,Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, 58183 Linköping, Sweden.;Cty Council Ostergotland, Dept Rehabil & Med, Rehab Vast. (författare)

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

Artikel/kapitelEngelska2017

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LIPPINCOTT WILLIAMS & WILKINS,2017
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LIBRIS-ID:oai:DiVA.org:uu-329700
https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-329700URI
https://doi.org/10.1097/MD.0000000000007274DOI
http://kipublications.ki.se/Default.aspx?queryparsed=id:136090103URI
https://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-139409URI

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Språk:engelska
Sammanfattning på:engelska

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Funding Agencies|Swedish Research Council; Swedish government through the REHSAM foundation; Medical Research Council of Southeast Sweden; County Council of Ostergotland; regional Center for Clinical Research; Centre for Clinical Research Sormland at Uppsala University; Uppsala-Orebro Regional Research Council, Sweden
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.

Ämnesord och genrebeteckningar

MEDICIN OCH HÄLSOVETENSKAP Hälsovetenskap Sjukgymnastik hsv//swe
MEDICAL AND HEALTH SCIENCES Health Sciences Physiotherapy hsv//eng
chronic
cost
cost-effectiveness
exercise
physiotherapy
rehabilitation
whiplash

Biuppslag (personer, institutioner, konferenser, titlar ...)

Peolsson, Anneli,1967-Linköpings universitet,Avdelningen för fysioterapi,Medicinska fakulteten,Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, 58183 Linköping, Sweden(Swepub:liu)annpe35 (författare)
Peterson, GunnelLinköpings universitet,Uppsala universitet,Centrum för klinisk forskning i Sörmland (CKFD),Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, 58183 Linköping, Sweden,Avdelningen för fysioterapi,Medicinska fakulteten,Uppsala University, Sweden(Swepub:liu)gunpe95 (författare)
Dedering, ÅsaKarolinska Institutet,Karolinska University Hospital, Sweden; Karolinska Institute, Sweden,Karolinska Univ Hosp, Allied Hlth Professionals Funct, Huddinge, Sweden.;Karolinska Inst, Div Physiotherapy, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden. (författare)
Johansson, GunKarolinska Institutet,Karolinska Institute, Sweden,Karolinska Inst, Inst Environm Med, Unit Occupat Med, Stockholm, Sweden. (författare)
Bernfort, LarsLinköpings universitet,Avdelningen för hälso- och sjukvårdsanalys,Medicinska fakulteten,Linkoping Univ, Dept Med & Hlth Sci, Div Hlth Care Anal, Linkoping, Sweden.(Swepub:liu)larbe72 (författare)
Linköpings universitetAvdelningen för fysioterapi (creator_code:org_t)

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Ingår i:Medicine: LIPPINCOTT WILLIAMS & WILKINS96:250025-79741536-5964

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Av författaren/redakt...: Landén Ludvigsso ...; Peolsson, Anneli ...; Peterson, Gunnel; Dedering, Åsa; Johansson, Gun; Bernfort, Lars

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