Gusi Narcís, Tomas-Carus Pablo
Faculty of Sports Sciences, University of Extremadura, Avda, Universidad s/n, 10071 Cáceres, Spain.
Arthritis Res Ther. 2008;10(1):R24. doi: 10.1186/ar2377. Epub 2008 Feb 22.
Physical therapy in warm water has been effective and highly recommended for persons with fibromyalgia, but its efficiency remains largely unknown. Should patients or health care managers invest in this therapy? The aim of the current study was to assess the cost-utility of adding an aquatic exercise programme to the usual care of women with fibromyalgia.
Costs to the health care system and to society were considered in this study that included 33 participants, randomly assigned to the experimental group (n = 17) or a control group (n = 16). The intervention in the experimental group consisted of a 1-h, supervised, water-based exercise sessions, three times per week for 8 months. The main outcome measures were the health care costs and the number of quality-adjusted life-years (QALYs) using the time trade-off elicitation technique from the EuroQol EQ-5D instrument. Sensitivity analyses were performed for variations in staff salary, number of women attending sessions and time spent going to the pool. The cost effectiveness acceptability curves were created using a non-parametric bootstrap technique.
The mean incremental treatment costs exceeded those for usual care per patient by euro 517 for health care costs and euro 1,032 for societal costs. The mean incremental QALY associated with the intervention was 0.131 (95% CI: 0.011 to 0.290). Each QALY gained in association with the exercise programme cost an additional euro 3,947/QALY (95% CI: 1,782 to 47,000) for a health care perspective and euro 7,878/QALY (3,559 to 93,818) from a societal perspective. The curves showed a 95% probability that the addition of the water-based programme is a cost-effective strategy if the ceiling of inversion is euro 14,200/QALY from a health care perspective and euro 28,300/QALY from a societal perspective.
The addition of an aquatic exercise programme to the usual care regime for fibromyalgia in women is cost effective in terms of both health care costs and societal costs. However, the characteristics of facilities (distance from the patients' homes and number of patients that can be accommodated per session) are major determinants to consider before investing in such a programme.
Current controlled trials ISRCTN53367487.
温水理疗对纤维肌痛患者有效且被强烈推荐，但该疗法的效率仍很大程度上未知。患者或医疗保健管理人员是否应投资于这种疗法？本研究的目的是评估在纤维肌痛女性的常规护理中增加水上运动计划的成本效益。
本研究考虑了医疗保健系统和社会的成本，研究包括33名参与者，随机分配到实验组（n = 17）或对照组（n = 16）。实验组的干预措施包括每周三次、每次1小时、有监督的水上运动课程，为期8个月。主要结局指标是医疗保健成本和使用欧洲五维健康量表（EuroQol EQ-5D）的时间权衡法得出的质量调整生命年（QALY）数量。对员工工资、参加课程的女性人数和前往游泳池所花费的时间的变化进行了敏感性分析。使用非参数自助法创建成本效益可接受性曲线。
从医疗保健成本来看，每位患者的平均增量治疗成本比常规护理超出517欧元，从社会成本来看超出1032欧元。与干预相关的平均增量QALY为0.131（95%可信区间：0.011至0.290）。从医疗保健角度来看，与运动计划相关的每获得一个QALY额外花费3947欧元/QALY（95%可信区间：1782至47000），从社会角度来看为7878欧元/QALY（3559至93818）。曲线显示，如果投资上限从医疗保健角度为14200欧元/QALY，从社会角度为28300欧元/QALY，那么增加水上运动计划有95%的概率是一种具有成本效益的策略。
在女性纤维肌痛的常规护理方案中增加水上运动计划，在医疗保健成本和社会成本方面都是具有成本效益的。然而，设施的特点（离患者家的距离以及每次课程可容纳的患者数量）是在投资此类计划之前需要考虑的主要决定因素。
当前对照试验ISRCTN53367487
