Cost-effectiveness evaluation of an RCT in rehabilitation after lumbar spinal fusion: a low-cost, behavioural approach is cost-effective over individual exercise therapy

Abstract

Recently, Christensen et al. reported the clinical effects of a low-cost rehabilitation program equally efficient to a relatively intensive program of individual, physiotherapist-guided exercise therapy. Yet, the low-cost approach is not fully supported as an optimal strategy until a full-scale economic evaluation, including extra-hospital effects such as service utilization in the primary health care sector and return-to-work, is conducted. The objective of this study was to conduct such evalution i.e. investigate the cost-effectiveness of (1) a low-cost rehabilitation regimen with a behavioural element and (2) a regimen of individual exercise therapy, both in comparison with usual practice, from a health economic, societal perspective. Study design was a cost-effectiveness evaluation of an RCT with a 2-year follow-up. Ninety patients having had posterolateral or circumferential fusion (indicated by chronic low back pain and localized pathology) were randomized 3 months after their spinal fusion. Validated pain-and disability index scales were applied at baseline and at 2 years postoperative. Costs were measured in a full-scale societal perspective. The probability of the behavioural approach being cost-effective was close to 1 given pain as the prioritized effect measure, and 0.8 to 0.6 (dependent on willingness to pay per effect unit) given disability as the prioritized effect measure. The probability of the exercise therapy approach being cost-effective was modest due to inferior effectiveness. Results proved robust to relevant sensitivity analysis although a differentiated cost-effectiveness ratio between males and females was suspected. In conclusion, a simple behavioural extension, of setting up group meetings for patients, to a regimen with a strict physiotherapeutic focus was found cost-effective, whereas the cost-effectiveness of increasing frequency and guidance of a traditional physiotherapeutic regimen was unlikely in present trial setting.

Cost-Effectiveness of Early Versus Delayed Functional Restoration for Chronic Disabling Occupational Musculoskeletal Disorders

“…Similar results on cost-effectiveness were reported when a biopsychosocial postoperative rehabilitation intervention was utilized following lumbar fusion surgery, relative to standard post-operative care (Sogaard, Bunger, Laurberg, & Christensen, 2008). The interdisciplinary rehabilitation group had a significantly greater, and constant, probability of being cost-effective in terms of improved pain and disability scores compared to the usual-care group.…”

The effect of timing of rehabilitation on physical performance after lumbar spinal fusion: a randomized clinical study

“…A study published in 2003 compared the effect of three different postoperative rehabilitation programs initiated 3 months after LSF. They found that groupbased intervention deploying a bio-psycho-social approach outperformed video instruction and intensive physiotherapy [2,6]. A study published in 2010 documented the superiority of a psychomotor therapy intervention focusing on cognition, behaviour and motor relearning activated 3-12 weeks after LSF [1].…”

The impact of economic evaluation on quality management in spine surgery

“…The conclusions could even be reverted when patients undergoing rehabilitation instead of surgery require secondary surgery. Similarly, we should consider the cost-effectiveness of the type of post-surgical rehabilitation as investigated by Soegaard et al [78].…”