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Fatoye F1, Wright J1, Gebrye T1
1Manchester Metropolitan University, Health Professions, Manchester, United Kingdom
Background: Low-back pain (LBP) remains a global health problem, affecting most adults at some point during their lifetime. It is a major source of morbidity, long-term pain, disability, psychological distress and productivity loss. It constitutes significant burden to individuals, health systems and society. Physiotherapy interventions are the mainstay management strategy for LBP and these interventions have been shown to be clinically effective, however, due to the nature of the condition the management for LBP can be resource intensive.
Purpose: The purpose of this review was to evaluate all recent economic evaluations of physiotherapy interventions.
Methods: A systematic review was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A literature search using CINAHL, Medline, the National Health Service Economic Evaluation database (NHSEED), Health Technology Assessment (HTA), and Database of Abstracts of Review of Effects (DARE) was conducted to identify original articles published between January 1, 2008 and June 19, 2018. Studies that evaluated the cost-effectiveness of physiotherapy interventions for LBP were included. Titles and abstracts were screened independently by TG and FF and disagreement was resolved through discussion. In order to assess the quality of reporting of these articles, a Consolidated Health Economic Evaluation Reporting Standards (CHEERS) tool was used.
Results: A total of 1531 articles were identified, and 12 studies fulfilled the inclusion criteria. The interventions reported in the studies varied from one study to another. Studies were conducted in the Australia, Brazil, Canada, Netherlands, Norway, and United Kingdom. The age of the population included in the studies ranged between 18 to 80 years. The types of economic evaluation conducted in the included studies were cost-effectiveness analysis (CEA) (n = 2), cost-utility analysis (CUA) (n = 4), CEA and CUA (n = 4), and CUA, CEA and cost-benefit analysis (n = 1). In all the studies economic evaluations were conducted from the healthcare and societal perspective for a period of 12 months. However, there was no study that examined the cost-effectiveness of physiotherapy interventions from patients or caregivers perspective. A group cognitive behavioural plus advice, novel motion-sensor biofeedback, individual exercise programme, and graded activities were all reported to be cost-effective interventions from the health care and societal perspective. The key drivers for costs of the interventions included visits to physiotherapy, medications, hospitalisation, out-of-pocket expenses and productivity loss.
Conclusion(s): The review found that physiotherapy interventions were cost-effective for LBP from the health care and societal perspective. The results of this review can help decision makers in prioritising healthcare interventions to improve the health outcomes of individuals with the condition. Clinicians and decision makers are to be aware of these findings as they may help to inform resource allocation for patients with LBP.
Implications: The findings of this review may help to facilitate efficient resource allocation to improve the health outcomes of patients with LBP. Future studies are required to examine the cost-effectiveness of physiotherapy interventions from patient and caregiver perspective.
Keywords: Cost-effectiveness, Physiotherapy, Low Back Pain
Funding acknowledgements: There was no funding received in support of this study.
Purpose: The purpose of this review was to evaluate all recent economic evaluations of physiotherapy interventions.
Methods: A systematic review was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A literature search using CINAHL, Medline, the National Health Service Economic Evaluation database (NHSEED), Health Technology Assessment (HTA), and Database of Abstracts of Review of Effects (DARE) was conducted to identify original articles published between January 1, 2008 and June 19, 2018. Studies that evaluated the cost-effectiveness of physiotherapy interventions for LBP were included. Titles and abstracts were screened independently by TG and FF and disagreement was resolved through discussion. In order to assess the quality of reporting of these articles, a Consolidated Health Economic Evaluation Reporting Standards (CHEERS) tool was used.
Results: A total of 1531 articles were identified, and 12 studies fulfilled the inclusion criteria. The interventions reported in the studies varied from one study to another. Studies were conducted in the Australia, Brazil, Canada, Netherlands, Norway, and United Kingdom. The age of the population included in the studies ranged between 18 to 80 years. The types of economic evaluation conducted in the included studies were cost-effectiveness analysis (CEA) (n = 2), cost-utility analysis (CUA) (n = 4), CEA and CUA (n = 4), and CUA, CEA and cost-benefit analysis (n = 1). In all the studies economic evaluations were conducted from the healthcare and societal perspective for a period of 12 months. However, there was no study that examined the cost-effectiveness of physiotherapy interventions from patients or caregivers perspective. A group cognitive behavioural plus advice, novel motion-sensor biofeedback, individual exercise programme, and graded activities were all reported to be cost-effective interventions from the health care and societal perspective. The key drivers for costs of the interventions included visits to physiotherapy, medications, hospitalisation, out-of-pocket expenses and productivity loss.
Conclusion(s): The review found that physiotherapy interventions were cost-effective for LBP from the health care and societal perspective. The results of this review can help decision makers in prioritising healthcare interventions to improve the health outcomes of individuals with the condition. Clinicians and decision makers are to be aware of these findings as they may help to inform resource allocation for patients with LBP.
Implications: The findings of this review may help to facilitate efficient resource allocation to improve the health outcomes of patients with LBP. Future studies are required to examine the cost-effectiveness of physiotherapy interventions from patient and caregiver perspective.
Keywords: Cost-effectiveness, Physiotherapy, Low Back Pain
Funding acknowledgements: There was no funding received in support of this study.
Topic: Musculoskeletal: spine; Globalisation: health systems, policies & strategies; Musculoskeletal: spine
Ethics approval required: No
Institution: Manchester Metropolitan University
Ethics committee: Not applicable
Reason not required: Ethical approval was not required for this study as it was a systematic review based on published papers.
All authors, affiliations and abstracts have been published as submitted.
