Cost-effectiveness of manual therapy versus physiotherapy in patients with sub-acute and chronic neck pain: a randomised controlled trial
J. M. van Dongen1 • R. Groeneweg1,2,3 • S. M. Rubinstein1 • J. E. Bosmans1 • R. A. B. Oostendorp2,4 • R. W. J. G. Ostelo1,5 • M. W. van Tulder1,5
Eur Spine J (2016) 25:2087–2096
Purpose: To evaluate the cost-effectiveness of manual therapy according to the Utrecht School (MTU) in comparison with physiotherapy (PT) in sub-acute and chronic non-specific neck pain patients from a societal perspective.
Methods: An economic evaluation was conducted alongside a 52-week randomized controlled trial, in which 90 patients were randomized to the MTU group and 91 to the PT group. Clinical outcomes included perceived recovery (yes/no), functional status (continuous and yes/no), and quality-adjusted life-years (QALYs). Costs were measured from a societal perspective using self-reported questionnaires. Missing data were imputed using multiple imputation. To estimate statistical uncertainty, bootstrapping techniques were used.
Results: After 52 weeks, there were no significant between-group differences in clinical outcomes. During follow-up, intervention costs (b:€-32; 95 %CI: -54 to -10) and healthcare costs (b:€-126; 95 %CI: -235 to -32) were significantly lower in the MTU group than in the PT group, whereas unpaid productivity costs were significantly higher (b:€186; 95 %CI:19–557). Societal costs did not significantly differ between groups (b:€-96; 95 %CI:-1975–2022). For QALYs and functional status (yes/no), the maximum probability of MTU being costeffective in comparison with PT was low (B0.54). For perceived recovery (yes/no) and functional status (continuous), a large amount of money must be paid per additional unit of effect to reach a reasonable probability of costeffectiveness.
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