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

*Corresponding author for this work

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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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