OBJECTIVES: The present study evaluated the cost-effectiveness of a behavioral graded exercise therapy (GET) program compared with usual care (UC) in terms of the performance of daily activities by patients with chronic shoulder complaints in primary care. METHODS: A total of 176 patients were randomly assigned either to GET (n = 87) or to UC (n = 89). Clinical outcomes (main complaints, shoulder disability (SDQ) and generic health-related quality of life (EQ-5D), and costs (intervention costs, direct health care costs, direct non-health-related costs, and indirect costs)) were assessed during the 12-week treatment period and at 52 weeks of follow-up. RESULTS: Results showed that GET was more effective than UC in restoring daily activities as assessed by the main complaints instrument after the 12-week treatment period (p = 0.049; mean difference, 7.5; confidence interval (CI) 0.0 to 15.0). These effects lasted for at least 52 weeks (p = 0.025; mean difference 9.2; CI 1.2 to 17.3). No statistically significant differences were found on the SDQ or EQ5D. GET significantly reduced direct health care costs (p = 0.000) and direct non-health care costs (p = 0.029). Nevertheless, total costs during the 1-year follow-up period were significantly higher (p = 0.001; GET Euro 530 versus UC Euro 377) due to the higher costs of the intervention. Incremental cost-effectiveness ratios for the main complaints (0 to 100), SDQ (0 to 100), and EQ-5D (-1.0 to 1.0) were Euro 17, Euro 74, and Euro 5,278 per unit of improvement, respectively. CONCLUSIONS: GET proved to be more effective in the short- and long-term and reduces direct health care costs and direct non-health care costs but is associated with higher costs of the intervention itself.

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