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The cost effectiveness of NHS physiotherapy support for occupational health (OH) services |
Phillips CJ, Phillips R, Main CJ, Watson PJ, Davies S, Farr A, Harper C, Noble G, Aylward M, Packman J, Downton M, Hale J |
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Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. CRD summary This study investigated the feasibility and potential cost-effectiveness of a pilot physiotherapy support for occupational health services. The authors concluded that the support service was potentially cost-effective. The economic methods were clearly stated, but the data were not reported in detail and the study was not fully transparent. This was a feasibility study and the exclusion of usual care as a comparator could be justified, but as a result the conclusions should not be considered to be robust. Type of economic evaluation Cost-effectiveness analysis, cost-utility analysis Study objective The aim was to examine the feasibility and cost-effectiveness of a pilot physiotherapy support for UK occupational health services. A pragmatic cohort of service users in the Occupational Health Physiotherapy Pilot Project (OHPPP) was evaluated. Interventions The OHPPP intervention had three stages. The first was physiotherapist telephone advice and triage; the second was physiotherapist face-to-face assessment and treatment in hospital, a workplace, or a clinic; and the third was physiotherapist assessments at work to promote return to work. The comparator was no intervention. Methods Analytical approach:A within-study cost-effectiveness analysis was undertaken using patient-level data directly from the pilot cohort. The time horizon of the analysis was 12 months. The authors stated that a UK NHS perspective was taken. Effectiveness data:The clinical outcomes were musculoskeletal pain measures; location-specific (arm, shoulder, hand, neck, etc.) pain measures; psychological outcomes, such as fear or avoidance; and health-related quality of life measures. Surveys were administered at enrolment, at the end of treatment, and at three months of follow-up. Baseline data were used as the comparator. The sample included 486 patients who completed questionnaires before and after treatment, with 54% retention at the end of treatment and 41% three months later. Uptake of the service was 54% of the anticipated uptake. Missing data were statistically handled by listwise exclusion. Completers and non-completers at follow-up were found to differ by age and European Quality of life (EQ-5D) questionnaire score. Monetary benefit and utility valuations:The utility weights were elicited during the pilot project, using the EQ-5D questionnaire. Measure of benefit:The measure of benefit was quality-adjusted life-years (QALYS). Cost data:The costs were evaluated using both a bottom-up and a top-down approach. For the top-down analysis, the values were from Welsh Assembly Government budgetary and expenditure records. For the bottom-up analysis, the resources were from the pilot project and they were valued using published unit cost data (page 195 of Curtis, et al. 2010, see ‘Other Publications of Related Interest’ below for bibliographic details). All costs were presented in UK £. Analysis of uncertainty:Some of the assumptions and inputs were varied in one-way sensitivity analyses. Results Compared with no intervention (baseline data), the changes in pain intensity, Short Form (SF-12) Health Survey mental and physical health scores, psychosocial measures, work-related absences, and work performance were all statistically significant at the end of treatment and at follow-up. The EQ-5D mean scores were 0.66 (SD 0.2) at baseline, 0.82 (SD 0.2) at end of treatment (p<0.001), and 0.82 (SD 0.2) at three-month follow-up (p<0.001). The cost per service user per contact hour was estimated to be £86. The cost per OHPPP user was £194 using a bottom-up approach or £360 using a top-down approach. The incremental QALYs with the OHPPP service were 0.047 at three-month follow-up or 0.14 over 12 months, per person. The estimated incremental cost per QALY gained was between £1,386 and £7,660 depending on the cost approach and QALY estimate used. Authors' conclusions The authors concluded that the OHPPP service was potentially cost-effective, for the UK NHS, and randomised controlled trials were needed. CRD commentary Interventions:The OHPPP service components were well described, but it was unclear how they compared with usual practice. It would have been useful to include usual practice as a comparator. The comparison with no intervention did not evaluate the true cost-effectiveness of the service. Effectiveness/benefits:The details of the clinical outcomes were clearly presented. The authors acknowledged that there was a high loss to follow-up, which reduced the generalisability of the service and its applicability to other populations. The study had a pre-post design rather than a randomised controlled trial design, leaving the findings open to bias. Costs:The resource use and the associated unit costs were not presented. Some details of the methods were presented, but without the actual data it is difficult to be sure that all relevant resources were considered. For example, it was unclear whether the costs of staff training and education, and any follow-up consultations were included. There was little detail for the individual costs (beyond the three broad components) and the relative burden was unclear as was their impact on the cost-effectiveness estimates. Analysis and results:The authors highlighted some limitations to their study, including the unanticipated low uptake of the service and the non-randomised design, which did not identify any changes occurring from spontaneous recovery. The authors stated that sensitivity analyses were undertaken, but the results were not presented. As previously mentioned, without the inclusion of usual care as a comparator, the analysis should be considered to be partial. Concluding remarks:The economic methods were clearly stated, but the data were not reported in detail and the study was therefore not fully transparent. This was a feasibility study and the exclusion of usual care as a comparator could be justified, but as a result the conclusions should not be considered to be robust. Funding Supported by a grant from the Welsh Assembly Government, UK. Bibliographic details Phillips CJ, Phillips R, Main CJ, Watson PJ, Davies S, Farr A, Harper C, Noble G, Aylward M, Packman J, Downton M, Hale J. The cost effectiveness of NHS physiotherapy support for occupational health (OH) services. BMC Musculoskeletal Disorders 2012; 13:29 Other publications of related interest Curtis L. Unit costs of health and social care. Canterbury, UK: Personal Social Services Research Unit. 2010. 1-253. Indexing Status Subject indexing assigned by NLM MeSH Adult; Cohort Studies; Cost-Benefit Analysis /statistics & Female; Humans; Male; Musculoskeletal Pain /economics /therapy; Occupational Diseases /economics /therapy; Occupational Health; Physical Therapy Modalities /economics; Pilot Projects; Quality of Life; State Medicine /economics; Surveys and Questionnaires; numerical data AccessionNumber 22012026043 Date bibliographic record published 21/08/2012 Date abstract record published 01/11/2012 |
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