OBJECTIVE: Cost-effectiveness analysis of supervised group physical therapy compared with unsupervised exercises at home in ankylosing spondylitis patients. DESIGN: Prospective randomized. SETTING: University Hospital Maastricht, the Netherlands. METHODS: A total of 144 patients with ankylosing spondylitis (according to the modified New York criteria; mean age 43 years) were randomized to unsupervised daily individualized exercises at home for 9 months or the same plus supervised group physical therapy (3 hours weekly). At baseline and after 9 months we measured spinal mobility (thoracolumbar flexion and extension), fitness (maximum capacity at ergometry), and patient's global assessment of change as measured on a visual analogue scale. We used a questionnaire at baseline and a diary during the trial to measure ankylosing spondylitis related direct medical costs, such as doctor visits, paramedical treatment, medication and hospitalization. RESULTS: The mean effects of group therapy and home exercises were, respectively, +0.9 cm (16%) and +0.5 cm (9%) for mobility (p < 0.01), +7 W (4%) and -2 W (-1%) for fitness (p = 0.05), and +1.7 (34%) and +0.3 (6%) for global health (p < 0.01). During the trial total medical costs decreased by an average of NOL 710 (44%) for group therapy, and by NOL 483 (35%) per patient per year for the 'home' group. Additional costs of group therapy were estimated at NOL 998 per patient per year. After the study 75% of the patients wanted to continue group physical therapy and were willing to pay for it. CONCLUSION: Compared with therapy at home, additional benefits of group therapy costed NOL 998 per year, but reduced direct medical costs by NOL 227 per year. Hence, the beneficial effects of group therapy cost NOL 771 per patient per year.

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