Skip to main content

Randomized trial of a brief physiotherapy intervention compared with usual physiotherapy for neck pain patients: Cost-effectiveness analysis

  • Andrea Manca (a1), David M. Epstein (a1), David J. Torgerson (a1), Jennifer A. Klaber Moffett (a2), Simon Coulton (a1), Amanda J. Farrin (a3), Seokyung Hahn (a4), David A. Jackson (a2) and Stewart J. Richmond (a2)...

Objectives: To assess the cost-effectiveness of brief physiotherapy intervention versus usual physiotherapy management in patients with neck pain of musculoskeletal origin in the community setting.

Methods: A cost-effectiveness analysis was conducted alongside a multicenter pragmatic randomized controlled clinical trial. Individuals 18 years of age and older with neck pain of more than 2 weeks were recruited from physiotherapy departments with referrals from general practitioners (GPs) in the East Yorkshire and North Lincolnshire regions in the United Kingdom. A total of 139 patients were allocated to the brief intervention, and 129 to the usual physiotherapy. Resource use data were prospectively collected on the number of physiotherapy sessions, hospital stay, specialist, and GP visits. Quality-adjusted life years (QALYs) were estimated using EQ-5D data collected at baseline, 3 and 12 months from the start of the treatment. The economic evaluation was conducted from the U.K. National Health System perspective.

Results: On average, brief intervention produced lower costs (£−68; 95 percent confidence interval [CI], £−103 to £−35) and marginally lower QALYs (−0.001; 95 percent CI, −0.030 to 0.028) compared with usual physiotherapy, resulting in an incremental cost per QALY of £68,000 for usual physiotherapy. These results are sensitive to patients' treatment preferences.

Conclusions: Usual physiotherapy may not be good value for money for the average individual in this trial but could be a cost-effective strategy for those who are indifferent toward which treatment they receive.

Hide All
Barber JA, Thompson SG. 2000 Analysis of cost data in randomised trials: An application of the non-parametric bootstrap. Stat Med. 19: 32193236.
Breen AC. 1996 Volumes and fees in UK chiropractic practice. Eur J Chiropractic. 44: 2326.
2003. BNF. British National Formulary (BNF). London: British Medical Association and the Royal Pharmaceutical Society of Great Britain;
2003. Department of Health. Reference cost 2001/2002. London: Department of Health;
Dolan P. 1997 Modeling valuations for EuroQol health states. Med Care. 35: 10951108.
Efron B, Tibshirani R. 1993. An Introduction to the Bootstrap. New York: Chapman and Hall;
Fenwick E, Claxton K, Sculpher MJ. 2001 Representing uncertainty: The role of cost-effectiveness acceptability curves. Health Econ. 10: 779789.
Hoch JS, Briggs AH, Willan A. 2002 Something old, something new, something borrowed, something BLUE: A framework for the marriage of health econometrics and cost-effectiveness analysis. Health Econ. 11: 415430.
Kind P. The EuroQoL instrument: An index of health-related quality of life. In: Spilker B, ed. 1996. Quality of life and pharmacoeconomics in clinical trials. Philadelphia: Lippincott-Raven;
Klaber Moffett JA, Jackson DA, Richmond S, et al. 2005 Randomised trial of a brief physiotherapy intervention compared with usual physiotherapy for neck pain patients: Outcomes and patient preference. Br Med J. 330: 7580.
Klaber Moffett JA, Torgerson DJ, Bell-Syer SB, et al. 1999 Randomised controlled trial of exercise for low back pain: Clinical outcomes, costs, and preferences. Br Med J. 319: 279283.
Korthals-de Bos IB, Hoving JL, van Tulder MW, et al. 2003 Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: Economic evaluation alongside a randomised controlled trial. Br Med J. 326: 911.
Lin DY, Feuer EJ, Etzioni R. 1997 Estimating medical costs from incomplete follow-up data. Biometrics. 53: 419434.
Lydick E, Epstein RS, Himmelberger D, White CJ. 1995 Area under the curve: A metric for patient subjective responses in episodic diseases. Qual Life Res. 4: 4145.
Manca A, Hawkins N, Sculpher MJ. 2005 Estimating mean QALYs in trial-based cost-effectiveness analysis: The importance of controlling for baseline utility. Health Econ. 14: 487496.
Matthews JNS, Altman D, Campbell M. 1990 Analysis of serial measurements in medical research. Br Med J. 300: 230235.
Mullner M. 2003 Commentary: Bootstrapping simplifies appreciation of statistical inferences. Br Med J. 326: 917.
Netten A, Dennett J, Knight J. 2002. Unit costs of health and social care. Canterbury: PSSRU, University of Kent;
NICE. Guide to the methods of technology appraisal. London: National Institute for Clinical Excellence; April 2004.
ONS. 2002. New earnings survey: Average gross weakly earnings by area. London: Office of National Statistics;
Pocock SJ, Assmann SE, Enos LE, Kasten LE. 2002 Subgroup analysis, covariate adjustment and baseline comparisons in clinical trial reporting: Current practice and problems. Stat Med. 21: 29172930.
Raftery J. 2001 NICE: Faster access to modern treatments? Analysis of guidance on health technologies. Br Med J. 323: 13001303.
Skargren EI, Carlsson PG, Oberg BE. 1998 One-year follow-up comparison of the cost and effectiveness of chiropractic and physiotherapy as primary management for back pain:subgroup analysis, recurrence, and additional health care utilization. Spine. 23: 18751883.
StataCorp. 1999. Stata statistical software. Version 7.0. College Station, TX: Stata Corporation;
Thomas E, Croft PR, Paterson SM, Dziedzic K, Hay EM. 2004 What influences participants' treatment preference and can it influence outcome? Results from a primary care-based randomised trial for shoulder pain. Br J Gen Pract. 54: 9396.
Torgerson DJ, Sibbald B. 1998; Understanding controlled trials: What is a patient preference trial? Br Med J. 316: 360.
Torgerson DJ, Raftery J. 1999 Economic Note: Outcomes. Br Med J. 318: 1413.
Van Hout BA, Al MJ, Gordon GS. 1994 Costs, effects and c/e-ratios alongside a clinical trial. Health Econ. 3: 309319.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Journal of Technology Assessment in Health Care
  • ISSN: 0266-4623
  • EISSN: 1471-6348
  • URL: /core/journals/international-journal-of-technology-assessment-in-health-care
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 2
Total number of PDF views: 34 *
Loading metrics...

Abstract views

Total abstract views: 171 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 20th November 2017. This data will be updated every 24 hours.