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Cost-effectiveness of a graded exercise therapy program for patients with chronic shoulder complaints

Published online by Cambridge University Press:  27 February 2006

Jacques J. X. R. Geraets ,
Mariëlle E. J. B. Goossens ,
Camiel P. C. de Bruijn ,
Imelda J. M. de Groot ,
Albère J. S. Köke ,
Rob A. G. B. Pelt ,
Geert van der Heijden ,
Geert-Jan Dinant  and
Wim J. A. van den Heuvel
Jacques J. X. R. Geraets
Affiliation:
Maastricht University and Institute for Rehabilitation Research
Mariëlle E. J. B. Goossens
Affiliation:
Maastricht University and Institute for Rehabilitation Research
Camiel P. C. de Bruijn
Affiliation:
Maastricht University and Institute for Rehabilitation Research
Imelda J. M. de Groot
Affiliation:
University Medical Centre de Radboud and Institute for Rehabilitation Research
Albère J. S. Köke
Affiliation:
Maastricht University and Center for Clinical Rehabilitation
Rob A. G. B. Pelt
Affiliation:
Center for Clinical Rehabilitation
Geert van der Heijden
Affiliation:
Utrecht University and University Medical Center Utrecht
Geert-Jan Dinant
Affiliation:
Maastricht University
Wim J. A. van den Heuvel
Affiliation:
Maastricht University and Institute for Rehabilitation Research
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Abstract

Objectives: The present study evaluated the cost-effectiveness of a behavioral graded exercise therapy (GET) program compared with usual care (UC) in terms of the performance of daily activities by patients with chronic shoulder complaints in primary care.

Methods: A total of 176 patients were randomly assigned either to GET (n=87) or to UC (n=89). Clinical outcomes (main complaints, shoulder disability [SDQ] and generic health-related quality of life [EQ-5D], and costs [intervention costs, direct health care costs, direct non–health-related costs, and indirect costs]) were assessed during the 12-week treatment period and at 52 weeks of follow-up.

Results: Results showed that GET was more effective than UC in restoring daily activities as assessed by the main complaints instrument after the 12-week treatment period (p=.049; mean difference, 7.5; confidence interval [CI], 0.0–15.0). These effects lasted for at least 52 weeks (p=.025; mean difference 9.2; CI, 1.2–17.3). No statistically significant differences were found on the SDQ or EQ5D. GET significantly reduced direct health care costs (p=.000) and direct non–health care costs (p=.029). Nevertheless, total costs during the 1-year follow-up period were significantly higher (p=.001; GET=€530 versus UC=€377) due to the higher costs of the intervention. Incremental cost-effectiveness ratios for the main complaints (0–100), SDQ (0–100), and EQ-5D (−1.0–1.0) were €17, €74, and €5,278 per unit of improvement, respectively.

Conclusions: GET proved to be more effective in the short- and long-term and reduces direct health care costs and direct non–health care costs but is associated with higher costs of the intervention itself.

Keywords

Cost-benefit analysisShoulderBehavior therapyRandomized controlled trials
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 22 , Issue 1 , January 2006 , pp. 76 - 83
Copyright
© 2006 Cambridge University Press

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References

Bergman GJD, van Tulder MW, Winters JC, et al. 2004: In: Bergman GJD, ed. Manipulative therapy for shoulder complaints in general practice. Groningen: Stichting Drukkerij C. Regenboog; 63– 77.
Beurskens AJ, de Vet HCW, Köke AJ, et al. 1999 A patient-specific approach for measuring functional status in low back pain. J Manipulative Physiol Ther. 22: 144– 183.Google Scholar
Brooks R. 1996 EuroQol: The current state of play. Health Policy. 37: 53– 72.Google Scholar
Campbell MK, Torgerson DJ. 1999 Bootstrapping: Estimating confidence intervals for cost-effectiveness ratios. QJM. 92: 177– 182.Google Scholar
Geraets JJ, Goossens ME, de Bruijn CP, et al. 2004 A behavioural treatment for chronic shoulder complaints: Concepts, development, and study design. Aust J Physiother. 50: 33– 38.Google Scholar
Geraets JJ, Goossens ME, de Groot IJ, et al. 2005 Effectiveness of a graded exercise therapy program for patients with chronic shoulder complaints. Aust J Physiother. 51: 87– 94.Google Scholar
Geraets JJ, Goossens ME, van Haastregt J, et al. Implications of process evaluation for clinical effectiveness and clinical practice in a trial on chronic shoulder complaints. Pat Educ Couns. In press.
Goossens ME, Evers SMAA. 1997 Economic evaluation in back pain interventions. J Occup Rehabil. 7: 15– 32.Google Scholar
Goossens ME, Rutten van Molken MP, Vlaeyen JW, et al. 2000 The cost diary: A method to measure direct and indirect costs in cost-effectiveness research. J Clin Epidemiol. 53: 688– 695.Google Scholar
Guzmán J, Esmail R, Karjalainen K, et al. 2001 Multidisciplinary rehabilitation for chronic low back pain: Systematic review. Br Med J. 322: 511– 516.Google Scholar
van der Heijden GJMG, Leffers P, Bouter LM. 2000 Shoulder disability questionnaire design and responsiveness of a functional status measure. J Clin Epidemiol. 53: 29– 38.Google Scholar
Luime JJ, Koes BW, Henriksen IJ, et al. 2004 Prevalence and incidence of shoulder pain in the general population: A systematic review. Scand J Rheumatol. 33: 73– 81.Google Scholar
Meerding WJL, Bonneux L, Polder JJ, et al. 1998 Demographic and epidemiological determinants of healthcare costs in the Netherlands: A cost of illness study. Br Med J. 317: 111– 115.Google Scholar
Morley S, Eccleston C, Williams A. 1999 Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache. Pain. 88: 1– 13.Google Scholar
Nygren A, Berglund A, von Koch M. 1995 Neck and shoulder pain, an increasing problem. Strategies for using insurance material to follow trends. Scand J Rehabil Med Suppl. 32: 107– 112.Google Scholar
O'Brien BJ, Brigg AH. 2002 Analysis of uncertainty in health care cost-effectiveness studies: An introduction to statistical issues and methods. Stat Methods Med Res. 11: 455– 468.Google Scholar
Oostenbrink JB, Bouwmans C, Koopmanschap MA, et al. 2004. Handleiding voor kostenonderzoek, methoden en standaard kostprijzen voor economische evaluaties in de gezondheidszorg. College voor zorgverzekeringen;
Picavet HSJ, Schouten JSAG. 2003 Musculoskeletal pain in the Netherlands: Prevalences, consequences and risk groups, the DMC (3)—study. Pain. 102: 167– 178.Google Scholar
van Tulder MW, Ostelo RWJG, Vlaeyen JWS, et al. 2001 A systematic review within the framework of the Cochrane Back Review Group. Spine. 26: 270– 281.Google Scholar
Waddell G. The back pain revolution. London: Churchill Livingstone; 1998: 103– 117, 351– 367.
Winters JC, de Jongh AC, van der Windt DAWM, et al. 1999 NHG-Standaard Schouderklachten. Huisarts en Wetenschap. 42: 222– 231.Google Scholar