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| Cost-effectiveness and activities of daily living in patients with complex regional pain syndrome type I |
| Jasmina T, Genchev G, Savova A, Dantchev N, Petrova G |
| International Journal of Pharmaceutical Sciences Review and Research 2012 Nov-Dec;17(1):16-21 |
| clinical trial |
| 3/10 [Eligibility criteria: Yes; Random allocation: No; Concealed allocation: No; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed* |
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Complex regional pain syndrome (CRPS) type I is a painful disabling sequel of a trauma of an extremity which requires long treatment. It has great socioeconomic importance because of the considerable impact on the patients' quality of life and activities of daily living as well as high health-care costs. The aim of this study was to assess the activities of daily living in CRPS type I patients in acute primary warm stage and to evaluate the cost-effectiveness of two physiotherapy methods in combination with adjunctive pain control pharmacotherapy in terms of the health-care system. 119 patients were treated respectively by two physiotherapy methods, ie, cryoelectrophoresis (CEP) and ice massage (IM), and a standard exercise programme. All received adjunctive pain control pharmacotherapy. This treatment was followed by a home-programme period for a month. The patients were evaluated before and after the treatment, and after the home-programme period regarding self-care, home, and professional activities of daily living (ADLs). The results showed significantly higher self-care and home ADLs (p < 0.05) for the CEP group as compared to the IM group. Regarding the professional activities, a significant difference for the CEP group was observed only at the follow-up assessment. The CEP treatment per patient was twice as expensive as this of the IM group. The cost-effectiveness analysis showed unambiguously that the treatment by IM is a therapy providing lower cost per unit of improvement in the three types of ADLs. The incremental cost-effectiveness ratio regarding CEP was below the threshold value of the gross domestic product per capita per year, thus meaning that CEP treatment is an efficient alternative for the Bulgarian health-care system. In conclusion, CEP treatment in combination with adjunctive pain control pharmacotherapy and exercise programme could be considered as a cost-effective therapy of CRPS type I patients in acute primary warm stage.
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