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Mbada CE1, Olaoye IM2, Fatoye C3, Gebrye T4, Fatoye F4
1Obafemi Awolowo University, Medical Rehabilitation, Ile Ife, Nigeria, 2Ladoke Akintola University of Technology Teaching Hospital, Department of Physiotherapy, Osogbo, Nigeria, 3Manchester Metropolitan University, Nursing, Manchester, United Kingdom, 4Manchester 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 mobility and productivity loss. Hence, LBP is associated with substantial economic burden to individuals, caregivers, health systems and society. Hence, it is associated with significant healthcare resource utilisation. Physiotherapy is the main stay management strategy for LBP, however, availability of physiotherapy services in resource-limited countries such as Nigeria can be challenging. As a result, telerehabilitation intervention is recommended for managing nonspecific chronic low back pain (NCLBP) in such countries.
Purpose: This study evaluated the cost-effectiveness of a telerehabilitation compared to clinic-based intervention for people with NCLBP in Nigeria.
Methods: A cost-utility analysis alongside a randomised controlled trial from a healthcare perspective was conducted. Patients with NCLBP were assigned into either telerehabilitation group (TG) or clinic-based intervention group (CBIG). Interventions were carried out three times weekly for a period of eight weeks. Patients' level of disability and physical and mental health were measured using Oswestry Disability Index (ODI) and a Short Form Survey (SF-12), respectively at baseline, week 4 and week 8. ODI and SF-12 scores were mapped to SF-6D and EQ-5D, respectively to estimate the health related quality of life of patients used to generate quality-adjusted life year (QALY) used for cost-effectiveness analysis. Healthcare cost questionnaire was administered to assess the direct healthcare costs of interventions after 8 weeks. Incremental cost effectiveness ratio (ICER) was calculated for telerehabilitation. Descriptive and inferential (independent t test) statistical analyses were performed using Statistical Packages for the Social Sciences (SPSS) Version.
Results: A total of 47 patients (TG, n = 21; CBIG, n = 26) with the mean (± SD) age of 47± (11.62) and 50 ± (10.67) years for the TG and CBIG, respectively participated in this study. QALY gained was 0.076 (EQ 5D) and 0.115 (SF 6D) for telerehabilitation, and 0.072 (EQ 5D) and 0.114 (SF 6D) for clinic-based intervention. The mean costs of telerehabilitation were $19.33 and clinic-based intervention was $46.94. Thus, ICER showed that telerehabilitation was a dominant intervention associated with a cost saving of $6,904/QALY gained (base on EQ-5D) and $27,610/QALY gained (based on SF 6D). However, there was no significant difference in ODI score (p = 0.777), SF 6D. (0.350) and QALY (p = 0.333) between TG and CBIG.
Conclusion(s): The findings of the study indicated that telerehabilitation was associated with greater QALY gain and lower costs suggesting that it was a cost-effective and cost-saving compared to a clinic-based intervention. Clinicians and policy makers are to be aware of the findings of the study as they may help to facilitate efficient resource allocation to improve the health outcomes of patients with CLBP.
Implications: The findings of the present study may help to facilitate efficient resource allocation of limited healthcare resources for patient with LBP in Nigeria. Future studies are required to assess the cost-effectiveness of telerehabilitation in the longer-term from patient and societal perspective using a larger sample size in developing countries.
Keywords: Telerehabilitation, Low Back Pain, Cost-effectiveness
Funding acknowledgements: Partly funded by African Doctoral Dissertation Research Fellowship by the African Population and Health Research Center/International Development Research Centre.
Purpose: This study evaluated the cost-effectiveness of a telerehabilitation compared to clinic-based intervention for people with NCLBP in Nigeria.
Methods: A cost-utility analysis alongside a randomised controlled trial from a healthcare perspective was conducted. Patients with NCLBP were assigned into either telerehabilitation group (TG) or clinic-based intervention group (CBIG). Interventions were carried out three times weekly for a period of eight weeks. Patients' level of disability and physical and mental health were measured using Oswestry Disability Index (ODI) and a Short Form Survey (SF-12), respectively at baseline, week 4 and week 8. ODI and SF-12 scores were mapped to SF-6D and EQ-5D, respectively to estimate the health related quality of life of patients used to generate quality-adjusted life year (QALY) used for cost-effectiveness analysis. Healthcare cost questionnaire was administered to assess the direct healthcare costs of interventions after 8 weeks. Incremental cost effectiveness ratio (ICER) was calculated for telerehabilitation. Descriptive and inferential (independent t test) statistical analyses were performed using Statistical Packages for the Social Sciences (SPSS) Version.
Results: A total of 47 patients (TG, n = 21; CBIG, n = 26) with the mean (± SD) age of 47± (11.62) and 50 ± (10.67) years for the TG and CBIG, respectively participated in this study. QALY gained was 0.076 (EQ 5D) and 0.115 (SF 6D) for telerehabilitation, and 0.072 (EQ 5D) and 0.114 (SF 6D) for clinic-based intervention. The mean costs of telerehabilitation were $19.33 and clinic-based intervention was $46.94. Thus, ICER showed that telerehabilitation was a dominant intervention associated with a cost saving of $6,904/QALY gained (base on EQ-5D) and $27,610/QALY gained (based on SF 6D). However, there was no significant difference in ODI score (p = 0.777), SF 6D. (0.350) and QALY (p = 0.333) between TG and CBIG.
Conclusion(s): The findings of the study indicated that telerehabilitation was associated with greater QALY gain and lower costs suggesting that it was a cost-effective and cost-saving compared to a clinic-based intervention. Clinicians and policy makers are to be aware of the findings of the study as they may help to facilitate efficient resource allocation to improve the health outcomes of patients with CLBP.
Implications: The findings of the present study may help to facilitate efficient resource allocation of limited healthcare resources for patient with LBP in Nigeria. Future studies are required to assess the cost-effectiveness of telerehabilitation in the longer-term from patient and societal perspective using a larger sample size in developing countries.
Keywords: Telerehabilitation, Low Back Pain, Cost-effectiveness
Funding acknowledgements: Partly funded by African Doctoral Dissertation Research Fellowship by the African Population and Health Research Center/International Development Research Centre.
Topic: Musculoskeletal: spine; Musculoskeletal; Globalisation: health systems, policies & strategies
Ethics approval required: Yes
Institution: Obafemi Awolowo University
Ethics committee: Health Research Ethical Committee of the Institute of Public Health
Ethics number: IPH/OAU/12/515
All authors, affiliations and abstracts have been published as submitted.
