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

J.J.X.R. Geraets, M.E.J.B. Goossens, C.P.C. de Bruijn, I. de Groot, A.J.A. Köke, R.A. Pelt, G.J. van der Heijden, G.J. Dinant, W.J.A. van Heuvel

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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.
Original languageEnglish
Pages (from-to)76-83
JournalInternational Journal of Technology Assessment in Health Care
Issue number1
Publication statusPublished - 1 Jan 2006

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