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A pragmatic randomised controlled trial of 'PhysioDirect' telephone assessment and advice services for patients with musculoskeletal problems: economic evaluation.


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

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Publications

A pragmatic randomised controlled trial of 'PhysioDirect' telephone assessment and advice services for patients with musculoskeletal problems: economic evaluation.

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]

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