Pain Exposure Physical Therapy versus conventional treatment in complex regional pain syndrome type 1-a cost-effectiveness analysis alongside a randomized controlled trial

Karlijn Barnhoorn, J Bart Staal, Robert Tm van Dongen, Jan Paul M Frölke, Frank P Klomp, Henk van de Meent, Eddy Adang, Maria Wg Nijhuis-van der Sanden, Karlijn Barnhoorn, J Bart Staal, Robert Tm van Dongen, Jan Paul M Frölke, Frank P Klomp, Henk van de Meent, Eddy Adang, Maria Wg Nijhuis-van der Sanden

Abstract

Objective: To analyze cost-effectiveness of Pain Exposure Physical Therapy compared to conventional treatment alongside a randomized controlled trial (NCT00817128) in patients with complex regional pain syndrome type 1, where no clinical difference was shown between the two groups in an intention-to-treat analysis.

Design: Randomized controlled trial with 9 months follow-up.

Setting: Patients were recruited from hospitals and general practitioners in the region around a university hospital.

Subjects: A total of 56 patients, 45 (80.4%) female, were randomized. About 4 patients in the intervention and 11 patients in the conventional group switched groups. The mean (SD) age was 44.3 (16.6) years, and in 37 (66.1%) patients, the upper extremity was affected.

Interventions: Patients received either Pain Exposure Physical Therapy (maximum of five sessions), or conventional treatment conforming with the Dutch multidisciplinary guideline.

Main measures: For the economic evaluation difference between the groups in health-related quality of life (quality-adjusted life years (QALYs)), and the clinical outcomes Impairment level Sum Score-Restricted Version and Pain Disability was determined based on the intention-to-treat analysis as well as differences in both healthcare-related costs and travel expenses. Cost-effectiveness planes were constructed using bootstrapping to compare effects and costs.

Results: No significant effects were found for QALYs (mean difference = -0.02; 95% confidence interval (CI) -0.10 to 0.04) and clinical outcomes. A cost minimization analysis showed a significant difference in costs between groups. The conventional treatment was 64% more expensive than the Pain Exposure Physical Therapy.

Conclusion: This economic analysis shows that Pain Exposure Physical Therapy compared to conventional treatment is cost-effective.

Keywords: Physical therapy; complex regional pain syndrome; cost-effectiveness; randomized controlled trial.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Patient flow.
Figure 2.
Figure 2.
Cost-effectiveness planes. ICER: Incremental Cost Effectiveness Ratio; ISS-RV: Impairment level Sum Score—Restricted Version; PDI: Pain Disability Index.

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Source: PubMed

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