Van Tubergen Astrid, Boonen Annelies, Landewé Robert, Rutten-Van Mölken Maureen, Van Der Heijde Désirée, Hidding Alita, Van Der Linden Sjef
University Hospital Maastricht, Maastricht, The Netherlands.
Arthritis Rheum. 2002 Oct 15;47(5):459-67. doi: 10.1002/art.10658.
To evaluate the cost effectiveness and cost utility of a 3-week course of combined spa therapy and exercise therapy in addition to standard treatment consisting of antiinflammatory drugs and weekly group physical therapy in ankylosing spondylitis (AS) patients.
A total of 120 Dutch outpatients with AS were randomly allocated into 3 groups of 40 patients each. Group 1 was treated in a spa resort in Bad Hofgastein, Austria; group 2 in a spa resort in Arcen, The Netherlands. The control group stayed at home and continued their usual activities and standard treatment during the intervention weeks. After the intervention, all patients followed weekly group physical therapy. The total study period was 40 weeks. Effectiveness of the intervention was assessed by functional ability using the Bath Ankylosing Spondylitis Function Index (BASFI). Utilities were measured with the EuroQoL (EQ-5D(utility)). A time-integrated summary score defined the clinical effects (BASFI-area under the curve [AUC]) and utilities (EQ-5D(utility)-AUC) over time. Both direct (health care and non-health care) and indirect costs were included. Resource utilization and absence from work were registered weekly by the patients in a diary. All costs were calculated from a societal perspective.
A total of 111 patients completed the diary. The between-group difference for the BASFI-AUC was 1.0 (95% confidence interval [95% CI] 0.4-1.6; P = 0.001) for group 1 versus controls, and 0.6 (95% CI 0.1-1.1; P = 0.020) for group 2 versus controls. The between-group difference for EQ-5D(utility)-AUC was 0.17 (95% CI 0.09-0.25; P < 0.001) for group 1 versus controls, and 0.08 (95% CI 0.00-0.15; P = 0.04) for group 2 versus controls. The mean total costs per patient (including costs for spa therapy) in Euros (euro;) during the study period were euro;3,023 for group 1, euro;3,240 for group 2, and euro;1,754 for the control group. The incremental cost-effectiveness ratio per unit effect gained in functional ability (0-10 scale) was euro;1,269 (95% CI 497-3,316) for group 1, and euro;2,477 (95% CI 601-12,098) for group 2. The costs per quality-adjusted life year gained were euro;7,465 (95% CI 3,294-14,686) for group 1, and euro;18,575 (95% CI 3,678-114,257) for group 2.
Combined spa-exercise therapy besides standard treatment with drugs and weekly group physical therapy is more effective and shows favorable cost-effectiveness and cost-utility ratios compared with standard treatment alone in patients with AS.
评估在强直性脊柱炎（AS）患者中，除了使用抗炎药物和每周进行一次集体物理治疗的标准治疗外，为期3周的温泉疗法与运动疗法相结合的治疗方案的成本效益和成本效用。
总共120名荷兰AS门诊患者被随机分为3组，每组40名患者。第1组在奥地利巴特霍夫加施泰因的一个温泉度假胜地接受治疗；第2组在荷兰阿尔森的一个温泉度假胜地接受治疗。对照组在家中，在干预周期间继续其日常活动和标准治疗。干预后，所有患者每周接受集体物理治疗。整个研究期为40周。使用巴斯强直性脊柱炎功能指数（BASFI）通过功能能力评估干预的有效性。使用欧洲五维度健康量表（EQ-5D（效用））测量效用。一个时间积分汇总分数定义了随时间的临床效果（BASFI-曲线下面积[AUC]）和效用（EQ-5D（效用）-AUC）。直接成本（医疗保健和非医疗保健）和间接成本均包括在内。患者每周通过日记记录资源利用情况和缺勤情况。所有成本均从社会角度计算。
总共111名患者完成了日记记录。第1组与对照组相比，BASFI-AUC的组间差异为1.0（95%置信区间[95%CI]0.4 - 1.6；P = 0.001），第2组与对照组相比为0.6（95%CI 0.1 - 1.1；P = 0.020）。第1组与对照组相比，EQ-5D（效用）-AUC的组间差异为0.17（95%CI 0.09 - 0.25；P < 0.001），第2组与对照组相比为0.08（95%CI 0.00 - 0.15；P = 0.04）。研究期间，每组患者的平均总成本（包括温泉疗法费用）以欧元（€）计，第1组为€3,023，第2组为€3,240，对照组为€1,754。第1组每获得一个单位功能能力（0 - 10分）的增量成本效益比为€1,269（95%CI 497 - 3,316），第2组为€2,477（95%CI 601 - 12,098）。第1组每获得一个质量调整生命年的成本为€7,465（95%CI 3,294 - 14,686），第2组为€18,575（95%CI 3,678 - 114,257）。
在AS患者中，除了药物标准治疗和每周集体物理治疗外，温泉 - 运动疗法相结合的治疗方案比单独的标准治疗更有效，并且显示出良好的成本效益和成本效用比。
