Exposure in vivo versus pain-contingent physical therapy in complex regional pain syndrome type I: A cost-effectiveness analysis

Marlies den Hollander*, Noortje Heijnders, Jeroen R. de Jong, Johan W.S. Vlaeyen, Rob J.E.M. Smeets, Mariëlle E.J.B. Goossens

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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OBJECTIVES: The aim of this study was to evaluate the cost-effectiveness of exposure in vivo (EXP, a cognitive-behavioral treatment targeting pain-related fear) in Complex Regional Pain Syndrome Type I (CRPS-I), as compared to pain-contingent physical therapy (PPT).

METHODS: Data from a randomized controlled trial were used to compare the cost-effectiveness of EXP versus PPT from a societal perspective. Intervention costs, other healthcare costs, costs to patient and family, and productivity losses were included. The main outcomes were changes in the SF-36 physical component scale and quality-adjusted life-years. Changes were followed until 6 months after treatment. Uncertainty was estimated using nonparametric bootstrap analysis, cost-effectiveness acceptability curves and cost-effectiveness planes. Sensitivity analyses were performed to check robustness of findings.

RESULTS: Forty-six patients were randomized and thirty-eight completed the study. Over 6 months, EXP resulted in greater improvement in physical health-related quality of life and quality-adjusted life-years than PPT. Despite higher initial treatment costs, EXP showed a tendency to reduce all costs compared with PPT; healthcare costs were significantly reduced. Furthermore, the cost-effectiveness planes were in favor of EXP. Sensitivity analyses, for different program costs and complete cases only, confirmed robustness of these findings.

CONCLUSIONS: EXP, a cognitive-behavioral treatment, seems more cost-effective than PPT in CRPS patients with pain-related fear. The initial higher costs for EXP are offset by a long-term reduction of costs for healthcare use, and a tendency to lower work absenteeism and reduced societal costs. Due to low sample sizes, replication of findings is required to confirm results.

Original languageEnglish
Pages (from-to)400-409
Number of pages10
JournalInternational Journal of Technology Assessment in Health Care
Issue number4
Early online date26 Jul 2018
Publication statusPublished - 2018


  • Journal Article
  • FEAR
  • Cost-effectiveness analysis
  • Exposure in vivo
  • CRPS-I
  • Rehabilitation
  • Pain-related fear
  • SF-36

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