• Spine · Aug 2011

    Randomized Controlled Trial Comparative Study

    Is behavioral graded activity cost-effective in comparison with manual therapy for patients with subacute neck pain? An economic evaluation alongside a randomized clinical trial.

    • Judith E Bosmans, Jan J M Pool, Henrica C W de Vet, Maurits W van Tulder, and Raymond W J G Ostelo.
    • Department of Health Sciences, VU University Amsterdam, Amsterdam, the Netherlands. judith.bosmans@falw.vu.nl
    • Spine. 2011 Aug 15;36(18):E1179-86.

    Study DesignAn economic evaluation alongside a randomized controlled trial comparing behavioral graded activity (BGA) with manual therapy (MT).ObjectiveTo evaluate the cost-effectiveness of BGA in comparison with MT for patients with subacute neck pain from a societal perspective.Summary Of Background DataNeck pain is common and poses an important socioeconomic burden to society. Data on the cost-effectiveness of treatments for neck pain are scarce.MethodsA randomized clinical trial was conducted, involving 146 patients with subacute nonspecific neck pain. The BGA program can be described as a time-contingent increase in activities from baseline toward predetermined goals. MT consists of specific spinal mobilization techniques and exercises. Clinical outcomes included recovery, pain, disability, and quality-adjusted life-years (QALYs). Costs were measured from a societal perspective using cost diaries. The follow-up period was 52 weeks. Multiple imputation was used for missing cost and effect data. Uncertainty surrounding cost differences and incremental cost-effectiveness ratios was estimated using bootstrapping. Cost-effectiveness planes and cost-effectiveness acceptability (CEA) curves were estimated.ResultsBGA had no significant effect on recovery or QALYs gained in comparison with MT but pain and disability did improve significantly in the BGA group in comparison with the MT group. Total societal costs in the BGA group were nonsignificantly higher than in the MT group. Cost-effectiveness analyses showed that BGA is not cost-effective in comparison with MT for recovery and QALYs gained. Substantial investments are needed to reach a 0.95 probability that BGA is cost-effective in comparison with MT for pain and disability.ConclusionOn the basis of the data presented, we consider BGA not cost-effective in comparison with MT.

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