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Economic Evaluation of a Behavioral-Graded Activity Program Compared to Physical Therapy for Patients Following Lumbar Disc Surgery

Ostelo, Raymond W. J. G., PhD, PT*‡; Goossens, Mariëlle E. J. B., PhD†§; de Vet, Henrica C. W., PhD; van den Brandt, Piet A., PhD*

doi: 10.1097/01.BRS.0000115130.42394.0B
Randomized Trial
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Study Design. An economic evaluation was conducted alongside a randomized controlled trial.

Summary of Background Data. Little is known about the effectiveness of cognitive-behavioral treatment options for patients following lumbar disc surgery. If the knowledge available was supported by an economic evaluation, the information could then be used to make recommendations for the implementation of cognitive-behavioral treatment in the routine of rehabilitation following lumbar disc surgery.

Objective. To examine the cost-effectiveness of a behavioral-graded activity program, which is an operant treatment, compared to usual care as delivered by a physical therapist for patients following first-time lumbar disc surgery.

Methods. For the economic evaluation, a societal viewpoint was applied. The primary outcome measures (measured at the 12-month follow-up) were global perceived effect and functional status. To evaluate the economic consequences of the treatments, direct health care and non-health care costs were considered, as well as indirect costs.

Results. The clinical outcomes showed no relevant differences between behavioral-graded activity (n = 52) and UC (n = 53). Treatment costs were almost identical in the two intervention groups. The difference in direct health care costs was, although not statistically significant, 264 EURO [95% CI: −3–525] higher in behavioral-graded activity than in usual care per patient-year. It was mainly the excess cost of visiting the physiotherapist in the behavioral-graded activity group that accounted for this difference. The difference in direct non-health care costs, although not statistically significant, was 388 EURO [95% CI: −217; 992] lower in the usual care group due to unpaid help by friends or family. Consequently, although again not statistically significant, the total direct costs in behavioral-graded activity are 639 EURO [95% CI: −91; 1368] higherthan in usual care. For the indirect costs, there was a statistically significant difference, behavioral-graded activity being more expensive. The sensitivity analysis showed that these results are fairly robust.

Conclusions. This study concludes that there are no differences between the two treatment conditions on any of the clinical outcome measures but that behavioral-graded activity is associated with higher costs. Consequently, there is no reason for the implementation of behavioral-graded activity as the standard treatment for patients following lumbar disc surgery.

An economic evaluation was conducted, alongside a randomized controlled trial, in which cost-effectiveness of a behavioral- graded activity program was compared to usual care, as delivered by a physical therapist, in patients following firsttime lumbar disc surgery. No differences were found in any of the clinical outcome measures. The costs associated with behavioral- graded activity were, however, higher as compared to usual care. Therefore, we conclude that, based on this economic evaluation, there is no need to implement the behavioral- graded activity program as delivered in the current study as the standard treatment for patients following lumbar disc surgery.

*Department of Epidemiology and

§Research Institute: Experimental Psychopathology, Maastricht University, Maastricht,

†Institute for Rehabilitation Research, Hoensbroek, and

‡VU University Medical Center, EMGO Institute, Amsterdam, The Netherlands.

Acknowledgment date: February 27, 2003.

First revision date: June 2, 2003.

Acceptance date: June 6, 2003.

The study was funded by grants of the ‘Profileringsfonds’ of the University Hospital Maastricht (azM) (Grant PF-57 B-96.1.996) and the Foundation ‘Annafonds’ Leiden, The Netherlands.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Institutional funds were received to support this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Raymond W.J.G. Ostelo, PhD, PT, VU University Medical Center, EMGO Institute, Van der Boechortsstraat 7, Amsterdam 1081 BT, The Netherlands; E-mail: r.ostelo@vumc.nl

© 2004 Lippincott Williams & Wilkins, Inc.