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Allet L1,2, Monnin D3, Berchtold A4
1HES-SO University of Applied Sciences Western Switzerland, Physiotherapy, Geneva, Switzerland, 2University of Geneva, Medical Faculty, Department of Community Medicine, Geneva, Switzerland, 3University Hospitals and University of Geneva, Geneva, Switzerland, 4University of Lausanne, Institute of Social Sciences and NCCR LIVES, Lausanne, Switzerland
Background: Health care costs are continually rising, particularly in the richest countries of the European community. Kocher et al. identified 292 different reasons for the exploding health care costs. The three main reasons were
a) medical technological progress and new pharmaceutics,
b) demographic ageing of the population and
c) increasing number of health care services, and a provider-induced demand.
Physiotherapists, like any healthcare professional, should evaluate how to make good work as economically as possible.
Purpose: The present project aimed to evaluate the cost-effectiveness of physiotherapy and to discuss the role of cost-effectiveness in decision making of health care policies in Switzerland and elsewhere in Europe.
Methods: In 2015 we published a systematic review about cost-effectiveness of physiotherapy. The present work is an update of the review published in 2015. We searched articles published between April 1st 2014 and January 1st 2017. Search strategy was conducted on Medline, Pedro, CINAHL and Cochrane using the following combination of English keywords: cost-effectiveness [Title/Abstract] AND (physical therapy [Title/Abstract] OR physiotherapy [Title/Abstract]). In addition we checked the reference list of all identified systematic reviews which responded to the selection criteria. Regarding economic analyses, we considered cost-effectiveness and cost-utility analyses. Our judgment of cost-effectiveness was based on the simplest possible definition of the Incremental Cost-Effectiveness Ratio (ICER): an intervention is considered to be cost-effective if it costs less than usual care for an equal or better benefit in terms of health. Finally, topic-centered interviews were conducted to discuss the role of such type of analysis in health care policies.
Results: Overall 156 articles published since April 2014 could be identified. After having screened the title and abstracts we retained 18 articles for the full text reading. Six new articles with high methodological quality of the economic analyses were included in the present updated review.
According to our definition none of the studies demonstrated cost-effectiveness of physiotherapy.
According to authors conclusions four out of six studies identified physiotherapy as cost-effective. Among those, two concerned the musculoskeletal domain, one study concerned COPD patients and one patients with treatment induced menopausal symptoms. In three out of these four studies treatments were active approaches (exercise therapy).
Topic-centered interviews revealed that quality criteria generally impact the decision making of health care policies in Switzerland and Europe but without having specific cost-effectiveness criteria per treatment.
Conclusion(s): Methodological differences between studies and different definitions of cost-effectiveness make it impossible to get a final answer to the question whether physiotherapy is cost-effective or not. Thus, the present work showed the importance - but also challenges - related with cost-effectiveness evaluations. Evaluating cost-effectiveness of physiotherapy is indispensable to become a credible partner within the healthcare system and future studies should agree on a single definition of cost-effectiveness.
Implications: It is most likely that active physical therapy interventions contribute to cost-effectiveness. Within that context we believe that health policy makers should give more credits to prevention programs. The topic-centered interviews allowed us to put into context the notion of cost-effectiveness in Switzerland and elsewhere in Europe.
Keywords: physiotherapy, health policies, cost-effectiveness
Funding acknowledgements: This project was not funded
a) medical technological progress and new pharmaceutics,
b) demographic ageing of the population and
c) increasing number of health care services, and a provider-induced demand.
Physiotherapists, like any healthcare professional, should evaluate how to make good work as economically as possible.
Purpose: The present project aimed to evaluate the cost-effectiveness of physiotherapy and to discuss the role of cost-effectiveness in decision making of health care policies in Switzerland and elsewhere in Europe.
Methods: In 2015 we published a systematic review about cost-effectiveness of physiotherapy. The present work is an update of the review published in 2015. We searched articles published between April 1st 2014 and January 1st 2017. Search strategy was conducted on Medline, Pedro, CINAHL and Cochrane using the following combination of English keywords: cost-effectiveness [Title/Abstract] AND (physical therapy [Title/Abstract] OR physiotherapy [Title/Abstract]). In addition we checked the reference list of all identified systematic reviews which responded to the selection criteria. Regarding economic analyses, we considered cost-effectiveness and cost-utility analyses. Our judgment of cost-effectiveness was based on the simplest possible definition of the Incremental Cost-Effectiveness Ratio (ICER): an intervention is considered to be cost-effective if it costs less than usual care for an equal or better benefit in terms of health. Finally, topic-centered interviews were conducted to discuss the role of such type of analysis in health care policies.
Results: Overall 156 articles published since April 2014 could be identified. After having screened the title and abstracts we retained 18 articles for the full text reading. Six new articles with high methodological quality of the economic analyses were included in the present updated review.
According to our definition none of the studies demonstrated cost-effectiveness of physiotherapy.
According to authors conclusions four out of six studies identified physiotherapy as cost-effective. Among those, two concerned the musculoskeletal domain, one study concerned COPD patients and one patients with treatment induced menopausal symptoms. In three out of these four studies treatments were active approaches (exercise therapy).
Topic-centered interviews revealed that quality criteria generally impact the decision making of health care policies in Switzerland and Europe but without having specific cost-effectiveness criteria per treatment.
Conclusion(s): Methodological differences between studies and different definitions of cost-effectiveness make it impossible to get a final answer to the question whether physiotherapy is cost-effective or not. Thus, the present work showed the importance - but also challenges - related with cost-effectiveness evaluations. Evaluating cost-effectiveness of physiotherapy is indispensable to become a credible partner within the healthcare system and future studies should agree on a single definition of cost-effectiveness.
Implications: It is most likely that active physical therapy interventions contribute to cost-effectiveness. Within that context we believe that health policy makers should give more credits to prevention programs. The topic-centered interviews allowed us to put into context the notion of cost-effectiveness in Switzerland and elsewhere in Europe.
Keywords: physiotherapy, health policies, cost-effectiveness
Funding acknowledgements: This project was not funded
Topic: Professional issues; Professional issues
Ethics approval required: No
Institution: HEdS et HUG
Ethics committee: Commission cantonale d'éthique de la recherche - CCER
Reason not required: No health data are collected
All authors, affiliations and abstracts have been published as submitted.
