Is a remotely delivered physiotherapy program delivered through an App, cost-effective compared with usual face to face care?

The aims were: 1) to determine whether remotely delivered physiotherapy was cost saving for the primary outcome (PSFS) measured at 6 weeks; 2) to determine whether the program was cost-effective compared with usual care. 

As remotely delivered physiotherapy was non-inferior to usual care, we carried out a cost-minimization analysis for the primary outcome (PFSF). We also carried out cost-utility analysis using quality adjusted life years (QALYs) during the 26 week follow up period. We used a health provider plus patient perspective. Health system costs included physiotherapists’ time delivering treatment, clinical space, administration support and other healthcare utilisation. Patient costs were self-reported and included time taken to travel to sessions, the cost of physiotherapy, receiving telephone calls, completing the exercise program and healthcare utilisation. All costs are reported in 2023 Australian Dollars (AUD). For the cost-utility analysis, QALYs were derived using the Australian valuation of EQ-5D-5L quality of life instrument. Baseline differences in utility scores were adjusted using regression methods. Bootstrapping of costs and outcomes was used to plot the results on cost-effectiveness planes and determine the probability of the intervention being cost saving for the primary outcome, and the probability of it being cost-effective for QALYs at the commonly used threshold of $50,000/QALY.

Health system plus patient costs were $742 per participant for remotely delivered physiotherapy and $910 for usual care, a saving of $168. When taking uncertainty into account the probability of remotely delivered physiotherapy being cost saving and effective for the PSFS outcome was 88%. For the QALY outcome, the probability of the intervention being cost-effective at a $50,000/QALY threshold was 41%. 

Remotely delivered physiotherapy is as good as usual care and costs less than face-to-face physiotherapy for the management of MSK conditions. Based on QALYs and standard thresholds, it is moderately cost-effective. There could be an economic benefit to moving some people with MSK conditions to a remote model of care without compromising on outcomes. 

Models of care that reduce patients’ dependence on regular face-to-face physiotherapy may reduce waiting times for physiotherapy in places of high demand thereby increasing access to physiotherapy for all patients. These findings are important for giving researchers confidence to further test similar models of care for different patients and in different clinical settings.