Cost-utility analysis of physiotherapy treatment compared with physiotherapy advice in low back pain.
Rivero-Arias O., Gray A., Frost H., Lamb SE., Stewart-Brown S.
STUDY DESIGN: Economic evaluation alongside a pragmatic multicenter randomized controlled trial from the National Health Service (NHS) and societal perspective. OBJECTIVE: To perform a cost-utility analysis of routine physiotherapy treatment compared with an assessment session and advice from a physiotherapist for patients with subacute and chronic low back pain. SUMMARY OF BACKGROUND DATA: Lack of evidence for some types of physiotherapy intervention and a paucity of cost-effectiveness data for treatment of low back pain has led to controversy and uncertainty within the medical and allied professions. PATIENTS AND METHODS: A total of 286 patients with low back pain of more than a 6-week duration were randomized to physiotherapy treatment or advice on remaining active from a physiotherapist. Data were collected on back pain-related NHS and patients' costs over a 12-month post randomization period. The primary outcome measure was the Oswestry Disability Index at 12 months, with additional Oswestry Disability Index measures at 2 and 6 months. The EuroQol EQ-5D was used to calculate quality adjusted life years. Cost-effectiveness was expressed as the incremental cost per quality adjusted life year gained. Uncertainty was handled using confidence ellipses for the ratio and cost-effectiveness acceptability curves. RESULTS: The total NHS costs were not significantly different at 179 pounds sterling (221 pounds sterling) for physiotherapy and 159 pounds sterling (260 pounds sterling) for the advice group. However, patients in the physiotherapy group had significantly higher out-of-pocket health care expenditure (40 pounds sterling, 95% confidence interval 9 pounds sterling to 71 pounds sterling). Utility levels improved in both groups from baseline to 12 months, with no significant differences between groups. CONCLUSIONS: The results indicate no significant differences in either NHS costs or effects. However, the significantly higher out-of-pocket expenses incurred by patients receiving routine physiotherapy suggests that advice given by a physiotherapist should be considered as the first-line treatment for patients with this level of back pain disability.