Hahne Andrew J, Ford Jon J, Surkitt Luke D, Richards Matthew C, Chan Alexander Y P, Slater Sarah L, Taylor Nicholas F
Low Back Research Team, School of Allied Health, La Trobe University, Melbourne, Victoria, Australia.
Physiotherapy Department, Northern Health, Epping, Victoria, Australia.
Spine (Phila Pa 1976). 2017 Feb;42(3):E169-E176. doi: 10.1097/BRS.0000000000001734.
A cost-utility analysis within a randomized controlled trial was conducted from the health care perspective.
The aim of this study was to determine whether individualized physical therapy incorporating advice is cost-effective relative to guideline-based advice alone for people with low back pain and/or referred leg pain (≥6 weeks, ≤6 months duration of symptoms).
Low back disorders are a burdensome and costly condition across the world. Cost-effective treatments are needed to address the global burden attributable to this condition.
Three hundred participants were randomly allocated to receive either two sessions of guideline-based advice alone (n = 144), or 10 sessions of individualized physical therapy targeting pathoanatomical, psychosocial and neurophysiological factors, and incorporating advice (n = 156). Data relating to health care costs, health benefits (EuroQol-5D) and work absence were obtained from participants via questionnaires at 5, 10, 26, and 52-week follow-ups.
Total health care costs were similar for both groups: mean difference $27.03 [95% confidence interval (95% CI): -200.29 to 254.35]. Health benefits across the 12-month follow-up were significantly greater with individualized physical therapy: incremental quality-adjusted life years = 0.06 (95% CI: 0.02-0.10). The incremental cost-effectiveness ratio was $422 per quality-adjusted life year gained. The probability that individualized physical therapy was cost-effective reached 90% at a willingness-to-pay threshold of $36,000. A saving of $1995.51 (95% CI: 143.98-3847.03) per worker in income was realized in the individualized physical therapy group relative to the advice group. Sensitivity and subgroup analyses all revealed a dominant position for individualized physical therapy; hence, the base case analysis was the most conservative.
Ten sessions of individualized physical therapy incorporating advice is cost-effective compared with two sessions of guideline-based advice alone for people with low back disorders.
从医疗保健角度在一项随机对照试验中进行成本-效用分析。
本研究旨在确定对于患有腰痛和/或腿部牵涉痛（症状持续时间≥6周、≤6个月）的患者，与仅基于指南的建议相比，结合建议的个体化物理治疗是否具有成本效益。
腰痛疾病在全球范围内都是一种负担沉重且成本高昂的病症。需要具有成本效益的治疗方法来应对归因于这种病症的全球负担。
300名参与者被随机分配，分别接受仅两次基于指南的建议（n = 144），或10次针对病理解剖、心理社会和神经生理因素并结合建议的个体化物理治疗（n = 156）。通过在5周、10周、26周和52周随访时向参与者发放问卷，获取与医疗保健成本、健康效益（欧洲五维健康量表）和缺勤情况相关的数据。
两组的总医疗保健成本相似：平均差异为27.03美元[95%置信区间（95%CI）：-200.29至254.35]。在12个月的随访中，个体化物理治疗带来的健康效益显著更大：增量质量调整生命年 = 0.06（95%CI：0.02 - 0.10）。每获得一个质量调整生命年的增量成本效益比为422美元。在支付意愿阈值为36,000美元时，个体化物理治疗具有成本效益的概率达到90%。相对于建议组，个体化物理治疗组每名工人的收入节省了1995.51美元（95%CI：143.98 - 3847.03）。敏感性分析和亚组分析均显示个体化物理治疗具有主导地位；因此，基础病例分析是最保守的。
对于患有腰痛疾病的患者，与仅两次基于指南的建议相比，10次结合建议的个体化物理治疗具有成本效益。
2级。
