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Cost-effectiveness of neck-specific exercise with or without a behavioral approach versus physical activity prescription in the treatment of chronic whiplash-associated disorders Analyses of a randomized clinical trial
Uppsala University, Sweden.
Uppsala University, Sweden.
Uppsala University, Sweden.
Karolinska University Hospital, Sweden; Karolinska Institute, Sweden.
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2017 (English)In: Medicine (Baltimore, Md.), ISSN 0025-7974, E-ISSN 1536-5964, Vol. 96, no 25, e7274Article in journal (Refereed) Published
Abstract [en]

Background: Fifty percent of people injured by whiplash still report neck pain after 1 year and costs associated with whiplash associated disorders (WAD) are mostly attributed to health service and sick-leave costs in chronic conditions. With increasing health care expenditures the economic impact of interventions needs to be considered. Objective: To analyze the cost-effectiveness of physiotherapist-led neck-specific exercise without (NSE) or with a behavioral approach (NSEB), or prescription of physical activity (PPA) in chronic WAD, grade 2 to 3. Methods: This is a secondary cost-effectiveness analysis of a multicenter randomized clinical trial of 216 participants with chronic WAD grade 2 to 3. The interventions were physiotherapist-led neck-specific exercise without or with a behavioral approach, or prescription of physical activity for 12 weeks. Incremental cost-effectiveness ratios (ICERs) were determined after 1 year and bootstrapped cost-effectiveness planes and sensitivity analyses of physiotherapy visits were performed. Health care and production loss costs were included and quality-adjusted life years (QALYs) were estimated, using the Euroqol-5D questionnaire. Comparisons with the Short Form-6D, and neck disability index (NDI) were also made. Results: The 1-year follow-up was completed by 170 participants (79%). Both physiotherapist-led groups improved in health related quality of life. The intervention cost alone, per quality-adjusted life year (QALY) gain in the NSE group was US$12,067. A trend for higher QALY gains were observed in the NSEB group but the costs were also higher. The ICERs varied depending on questionnaire used, but the addition of a behavioral approach to neck-specific exercise alone was not cost-effective from a societal perspective (ICER primary outcome $127,800 [95% confidence interval [CI], 37,816-711,302]). The sensitivity analyses confirmed the results. The prescription of physical activity did not result in any QALY gain and the societal costs were not lower. Conclusion: Neck-specific exercise was cost-effective from a societal perspective in the treatment of chronic WAD compared with the other exercise interventions. ICERS varied depending on health-related quality of life questionnaires used, but the addition of a behavioral approach was not cost-effective from a societal perspective. The prescription of physical activity did not result in any QALY gain and was thus not considered a relevant option.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS , 2017. Vol. 96, no 25, e7274
Keyword [en]
chronic; cost; cost-effectiveness; exercise; physiotherapy; rehabilitation; whiplash
National Category
Physiotherapy
Identifiers
URN: urn:nbn:se:liu:diva-139409DOI: 10.1097/MD.0000000000007274ISI: 000404116900065PubMedID: 28640136OAI: oai:DiVA.org:liu-139409DiVA: diva2:1129854
Note

Funding Agencies|Swedish Research Council; Swedish government through the REHSAM foundation; Medical Research Council of Southeast Sweden; County Council of Ostergotland; regional Center for Clinical Research; Centre for Clinical Research Sormland at Uppsala University; Uppsala-Orebro Regional Research Council, Sweden

Available from: 2017-08-07 Created: 2017-08-07 Last updated: 2017-08-27

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