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ABSTRACT: 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 (1506 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=1272). Total NHS costs, including the cost of physiotherapy were higher in the PhysioDirect group by £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 £2889 and the net monetary benefit at ?=£20 000 was £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.
SUBMITTER: Hollinghurst S
PROVIDER: S-EPMC3796275 | biostudies-literature | 2013 Oct
REPOSITORIES: biostudies-literature
Hollinghurst Sandra S Coast Joanna J Busby John J Bishop Annette A Foster Nadine E NE Franchini Angelo A Grove Sean S Hall Jeanette J Hopper Cherida C Kaur Surinder S Montgomery Alan A AA Salisbury Chris C
BMJ open 20131003 10
<h4>Objectives</h4>To compare the cost-effectiveness of PhysioDirect with usual physiotherapy care for patients with musculoskeletal problems.<h4>Design</h4>(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).<h4>Setting</h4>Four physiotherapy services in England.<h4>Participants</h4>Adults (18+) referred by ...[more]