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Miyamoto GC1,2, van Dongen JM2, van Tulder MW2, Cabral CMN1
1Universidade Cidade de São Paulo, São Paulo, Brazil, 2Vrije Universiteit Amsterdam, Amsterdam, Netherlands
Background: Low back pain is a serious public health problem with enormous costs. Although Pilates method has been recommended for the treatment of chronic low back pain, there is still no evidence about the cost-effectiveness for global perceived effect.
Purpose: To investigate the cost-effectiveness of different doses of Pilates in the treatment of patients with non-specific chronic low back pain.
Methods: 296 patients aged 18 to 80 years were randomly allocated to four treatment groups (n=74 per group): booklet group (BG) did not receive additional treatment, Pilates group 1 (PG1) received treatment once a week, Pilates group 2 (PG2) received treatment twice a week and Pilates group 3 (PG3) received treatment three times a week. All groups received an educational booklet. The intervention lasted six weeks. The clinical outcome was global perceived effect at 12 months after randomization, measured by the Global Perceived Effect Scale (-5 to +5). The economic evaluation was conducted from a societal perspective with a follow-up of 12 months. The total societal costs included intervention costs (booklet costs and estimation of the number of Pilates sessions offered to the patients during the intervention period), direct costs (medical and non-medical costs), and indirect costs (hours of absence from paid and unpaid work). Cost-effectiveness analysis was performed using seemingly unrelated regression analysis.
Results: Only PG3 was statistically significant more effective than BG for global perceived effect (mean difference: 0.8,95% CI: 0.1 to 1.5) at 12 months after randomization. However, this difference may be considered a small effect. There were no significant differences for total societal costs in the Pilates groups compared with the BG. The incremental cost-effectiveness ratios indicate that one point of deterioration in global perceived effect was on average associated with a societal cost saving of £514 for PG1 (i.e. less costly and less effective), while one point of improvement in global perceived effectwas on average associated with a societal cost of £665 for PG2 and £233 for PG3 (i.e. more costly and more effective) compared with the BG. The cost-effectiveness acceptability curves for the comparisons between the four interventions showed that the probabilities of cost-effectiveness for global perceived effect were about 0.32 in BG, 0.67 in PG1, 0.01 in PG2, and 0.01 in PG3 at a willingness-to-pay of zero per point of improvement. At a willingness-to-pay of £5000 per improvement in global perceived effect, the cost-effectiveness acceptability curves for the comparisons between the four groups showed that the probabilities of cost-effectiveness for global perceived effect were about 0.02 in BG, 0.01 in PG1, 0.15 in PG2, and 0.83 in PG3. Thus, Pilates three times a week was the preferred option with the highest probability of being cost-effective.
Conclusion(s): Economic evaluation showed that Pilates three times a week may probably be considered cost-effective, although this depends upon the willingness-to-pay of decision-makers.
Implications: These results may help in decision making related to implementation of Pilates method as a cost-effective intervention for patients with chronic low back pain.
Keywords: Low back pain, Pilates, Economic evaluation
Funding acknowledgements: The authors thank the São Paulo Research Foundation (FAPESP) (process number: 2013/26321-8 and 2016/07915-2) for financial support.
Purpose: To investigate the cost-effectiveness of different doses of Pilates in the treatment of patients with non-specific chronic low back pain.
Methods: 296 patients aged 18 to 80 years were randomly allocated to four treatment groups (n=74 per group): booklet group (BG) did not receive additional treatment, Pilates group 1 (PG1) received treatment once a week, Pilates group 2 (PG2) received treatment twice a week and Pilates group 3 (PG3) received treatment three times a week. All groups received an educational booklet. The intervention lasted six weeks. The clinical outcome was global perceived effect at 12 months after randomization, measured by the Global Perceived Effect Scale (-5 to +5). The economic evaluation was conducted from a societal perspective with a follow-up of 12 months. The total societal costs included intervention costs (booklet costs and estimation of the number of Pilates sessions offered to the patients during the intervention period), direct costs (medical and non-medical costs), and indirect costs (hours of absence from paid and unpaid work). Cost-effectiveness analysis was performed using seemingly unrelated regression analysis.
Results: Only PG3 was statistically significant more effective than BG for global perceived effect (mean difference: 0.8,95% CI: 0.1 to 1.5) at 12 months after randomization. However, this difference may be considered a small effect. There were no significant differences for total societal costs in the Pilates groups compared with the BG. The incremental cost-effectiveness ratios indicate that one point of deterioration in global perceived effect was on average associated with a societal cost saving of £514 for PG1 (i.e. less costly and less effective), while one point of improvement in global perceived effectwas on average associated with a societal cost of £665 for PG2 and £233 for PG3 (i.e. more costly and more effective) compared with the BG. The cost-effectiveness acceptability curves for the comparisons between the four interventions showed that the probabilities of cost-effectiveness for global perceived effect were about 0.32 in BG, 0.67 in PG1, 0.01 in PG2, and 0.01 in PG3 at a willingness-to-pay of zero per point of improvement. At a willingness-to-pay of £5000 per improvement in global perceived effect, the cost-effectiveness acceptability curves for the comparisons between the four groups showed that the probabilities of cost-effectiveness for global perceived effect were about 0.02 in BG, 0.01 in PG1, 0.15 in PG2, and 0.83 in PG3. Thus, Pilates three times a week was the preferred option with the highest probability of being cost-effective.
Conclusion(s): Economic evaluation showed that Pilates three times a week may probably be considered cost-effective, although this depends upon the willingness-to-pay of decision-makers.
Implications: These results may help in decision making related to implementation of Pilates method as a cost-effective intervention for patients with chronic low back pain.
Keywords: Low back pain, Pilates, Economic evaluation
Funding acknowledgements: The authors thank the São Paulo Research Foundation (FAPESP) (process number: 2013/26321-8 and 2016/07915-2) for financial support.
Topic: Musculoskeletal
Ethics approval required: Yes
Institution: Universidade Cidade de São Paulo
Ethics committee: Research Ethics Committee of Universidade Cidade de São Paulo
Ethics number: (CAAE: 29303014.7.0000.0064)
All authors, affiliations and abstracts have been published as submitted.
