A pragmatic randomised controlled trial of 'PhysioDirect' telephone assessment and advice services for patients with musculoskeletal problems: economic evaluation.
Hollinghurst, S; Coast, J; Busby, J; Bishop, A; Foster, NE; Franchini, A; Grove, S; Hall, J; Hopper, C; Kaur, S; Montgomery, AA; Salisbury, C; (2013) A pragmatic randomised controlled trial of 'PhysioDirect' telephone assessment and advice services for patients with musculoskeletal problems: economic evaluation. BMJ Open, 3 (10). e003406. ISSN 2044-6055 DOI: https://doi.org/10.1136/bmjopen-2013-003406
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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 λ=£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.
| Item Type: | Article |
|---|---|
| Faculty and Department: | Faculty of Epidemiology and Population Health > Dept of Non-Communicable Disease Epidemiology |
| PubMed ID: | 24091423 |
| Web of Science ID: | 326882800027 |
| URI: | http://researchonline.lshtm.ac.uk/id/eprint/1831382 |
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