A pragmatic randomised controlled trial of %26apos;PhysioDirect%26apos; telephone assessment and advice services for patients with musculoskeletal problems: economic evaluation

作者：Hollinghurst Sandra^*; Coast Joanna; Bu**y John; Bishop Annette; Foster Nadine E; Franchini Angelo; Grove Sean; Hall Jeanette; Hopper Cherida; Kaur Surinder; Montgomery Alan A; Sali**ury Chris

来源：BMJ Open, 2013, 3(10): e003406.

DOI：10.1136/bmjopen-2013-003406

• economic evaluation
• physiotherapy
• telehealth
• PRIMARY CARE
• costs %26 cost analysis

Objectives To compare the cost-effectiveness of PhysioDirect with usual physiotherapy care for patients with musculoskeletal problems. %26lt;br%26gt;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). %26lt;br%26gt;Setting Four physiotherapy services in England. %26lt;br%26gt;Participants Adults (18+) referred by their general practitioner or self-referred for physiotherapy. %26lt;br%26gt;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. %26lt;br%26gt;Primary and secondary outcomes Primary clinical outcome: physical component summary from the SF-36v2 at 6months. 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. %26lt;br%26gt;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 pound to 76.19) pound and there was a QALY gain of 0.007 (95% CI -0.003 to 0.016). The incremental cost-effectiveness ratio was 2889 pound and the net monetary benefit at =20000 pound was 117 pound (95% CI -86 pound to 310) pound. %26lt;br%26gt;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.

• 出版日期2013