行为分级活动与手法治疗相比，对亚急性颈痛患者更具成本效益吗？一项随机临床试验的经济学评价。
Is behavioral graded activity cost-effective in comparison with manual therapy for patients with subacute neck pain? An economic evaluation alongside a randomized clinical trial.
机构信息
Department of Health Sciences, VU University Amsterdam, Amsterdam, the Netherlands.
出版信息
Spine (Phila Pa 1976). 2011 Aug 15;36(18):E1179-86. doi: 10.1097/BRS.0b013e31820644ed.
STUDY DESIGN
An economic evaluation alongside a randomized controlled trial comparing behavioral graded activity (BGA) with manual therapy (MT).
OBJECTIVE
To evaluate the cost-effectiveness of BGA in comparison with MT for patients with subacute neck pain from a societal perspective.
SUMMARY OF BACKGROUND DATA
Neck pain is common and poses an important socioeconomic burden to society. Data on the cost-effectiveness of treatments for neck pain are scarce.
METHODS
A randomized clinical trial was conducted, involving 146 patients with subacute nonspecific neck pain. The BGA program can be described as a time-contingent increase in activities from baseline toward predetermined goals. MT consists of specific spinal mobilization techniques and exercises. Clinical outcomes included recovery, pain, disability, and quality-adjusted life-years (QALYs). Costs were measured from a societal perspective using cost diaries. The follow-up period was 52 weeks. Multiple imputation was used for missing cost and effect data. Uncertainty surrounding cost differences and incremental cost-effectiveness ratios was estimated using bootstrapping. Cost-effectiveness planes and cost-effectiveness acceptability (CEA) curves were estimated.
RESULTS
BGA had no significant effect on recovery or QALYs gained in comparison with MT but pain and disability did improve significantly in the BGA group in comparison with the MT group. Total societal costs in the BGA group were nonsignificantly higher than in the MT group. Cost-effectiveness analyses showed that BGA is not cost-effective in comparison with MT for recovery and QALYs gained. Substantial investments are needed to reach a 0.95 probability that BGA is cost-effective in comparison with MT for pain and disability.
CONCLUSION
On the basis of the data presented, we consider BGA not cost-effective in comparison with MT.
研究设计
一项经济评价与随机对照试验相结合，比较行为分级活动（BGA）与手动治疗（MT）。
目的
从社会角度评价 BGA 与 MT 治疗亚急性颈痛患者的成本效益。
背景资料总结
颈部疼痛很常见，给社会带来了重要的社会经济负担。有关颈部疼痛治疗成本效益的数据稀缺。
方法
进行了一项随机临床试验，涉及 146 名患有亚急性非特异性颈部疼痛的患者。BGA 方案可以描述为从基线向预定目标的时间依赖性增加活动。MT 包括特定的脊柱动员技术和运动。临床结果包括恢复、疼痛、残疾和质量调整生命年（QALYs）。从社会角度使用成本日记来衡量成本。随访期为 52 周。对于缺失的成本和效果数据，使用多重插补法。使用自举法估计成本差异和增量成本效益比的不确定性。估计成本效益平面和成本效益可接受性（CEA）曲线。
结果
与 MT 相比，BGA 对恢复或获得的 QALYs 没有显著影响，但与 MT 相比，BGA 组的疼痛和残疾明显改善。BGA 组的总社会成本显著高于 MT 组。成本效益分析表明，与 MT 相比，BGA 在恢复和获得 QALYs 方面没有成本效益。需要大量投资才能使 BGA 在疼痛和残疾方面与 MT 相比具有成本效益的概率达到 0.95。
结论
根据提出的数据，我们认为 BGA 与 MT 相比没有成本效益。
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