Use the Back button in your browser to see the other results of your search or to select another record.
A pragmatic randomised controlled trial of 'PhysioDirect' telephone assessment and advice services for patients with musculoskeletal problems: economic evaluation [with consumer summary] |
Hollinghurst S, Coast J, Busby J, Bishop A, Foster NE, Franchini A, Grove S, Hall J, Hopper C, Kaur S, Montgomery AA, Salisbury C |
BMJ Open 2013 Oct;3(10):e003406 |
clinical trial |
4/10 [Eligibility criteria: Yes; Random allocation: Yes; 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* |
OBJECTIVES: To compare the cost-effectiveness of PhysioDirect with usual physiotherapy care for patients with musculoskeletal problems. DESIGN: (1) Cost-consequences comparing cost to the National Health Service (NHS), to patients, and the value of lost productivity with a range of outcomes. (2) Cost-utility analysis comparing cost to the NHS with Quality-Adjusted Life Years (QALYs). SETTING: Four physiotherapy services in England. PARTICIPANTS: Adults (18+) referred by their general practitioner or self-referred for physiotherapy. INTERVENTIONS: PhysioDirect involved telephone assessment and advice followed by face-to-face care if needed. Usual care patients were placed on a waiting list for face-to-face care. PRIMARY AND SECONDARY OUTCOMES: Primary clinical outcome: physical component summary from the SF-36v2 at 6 months. Also included in the cost-consequences: Measure Yourself Medical Outcomes Profile; a Global Improvement Score; response to treatment; patient satisfaction; waiting time. Outcome for the cost-utility analysis: QALYs. RESULTS: 2249 patients took part (1,506 PhysioDirect; 743 usual care). (1) Cost-consequences: there was no evidence of a difference between the two groups in the cost of physiotherapy, other NHS services, personal costs or value of time off work. Outcomes were also similar. (2) Cost-utility analysis based on complete cases (n = 1,272). Total NHS costs, including the cost of physiotherapy were higher in the PhysioDirect group by Great British Pounds 19.30 (95% CI -37.60 to 76.19) and there was a QALY gain of 0.007 (95% CI -0.003 to 0.016). The incremental cost-effectiveness ratio was Great British Pounds 2,889 and the net monetary benefit at lambda = Great British Pounds 20,000 was Great British Pounds 117 (95% CI -86 to 310). CONCLUSIONS: PhysioDirect may be a cost-effective alternative to usual physiotherapy care, though only with careful management of staff time. Physiotherapists providing the service must be more fully occupied than was possible under trial conditions: consideration should be given to the scale of operation, opening times of the service and flexibility in the methods used to contact patients.
|