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

Raymond W.J.G. Ostelo, Mariëlle E.J.B. Goossens, Henrica C.W. De Vet, Piet A. Van Den Brandt

    Research output: Contribution to journalArticleAcademicpeer-review

    Abstract

    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 cifferences 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] higher than 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.

    Original languageEnglish
    Pages (from-to)615-622
    Number of pages8
    JournalSpine
    Volume29
    Issue number6
    DOIs
    Publication statusPublished - 15 Mar 2004

    Cite this

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    title = "Economic Evaluation of a Behavioral-Graded Activity Program Compared to Physical Therapy for Patients Following Lumbar Disc Surgery",
    abstract = "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 cifferences 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] higher than 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.",
    keywords = "Behavioral treatment, Economic evaluation, Low back pain, Lumbar disc surgery, Randomized controlled trial",
    author = "Ostelo, {Raymond W.J.G.} and Goossens, {Mari{\"e}lle E.J.B.} and {De Vet}, {Henrica C.W.} and {Van Den Brandt}, {Piet A.}",
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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.; Goossens, Mariëlle E.J.B.; De Vet, Henrica C.W.; Van Den Brandt, Piet A.

    In: Spine, Vol. 29, No. 6, 15.03.2004, p. 615-622.

    Research output: Contribution to journalArticleAcademicpeer-review

    TY - JOUR

    T1 - Economic Evaluation of a Behavioral-Graded Activity Program Compared to Physical Therapy for Patients Following Lumbar Disc Surgery

    AU - Ostelo, Raymond W.J.G.

    AU - Goossens, Mariëlle E.J.B.

    AU - De Vet, Henrica C.W.

    AU - Van Den Brandt, Piet A.

    PY - 2004/3/15

    Y1 - 2004/3/15

    N2 - 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 cifferences 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] higher than 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.

    AB - 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 cifferences 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] higher than 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.

    KW - Behavioral treatment

    KW - Economic evaluation

    KW - Low back pain

    KW - Lumbar disc surgery

    KW - Randomized controlled trial

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    U2 - 10.1097/01.BRS.0000115130.42394.0B

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    EP - 622

    JO - Spine

    JF - Spine

    SN - 0362-2436

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