EXPOSURE IN VIVO VERSUS PAIN-CONTINGENT PHYSICAL THERAPY IN COMPLEX REGIONAL PAIN SYNDROME TYPE I: A COST-EFFECTIVENESS ANALYSIS

EXPOSURE IN VIVO VERSUS PAIN-CONTINGENT PHYSICAL THERAPY IN COMPLEX REGIONAL PAIN SYNDROME TYPE I: A COST-EFFECTIVENESS ANALYSIS

The aim of this study was to evaluate the cost-effectiveness of exposure in vivo (EXP, a cognitive-behavioral treatment targeting pain-related fear) in Complex Regional Pain Syndrome Type I (CRPS-I), as compared to pain-contingent physical therapy (PPT). Data from a randomized controlled trial were...

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Bibliographic Details
Published in:International journal of technology assessment in health care Vol. 34; no. 4; p. 400
Main Authors: den Hollander, Marlies, Heijnders, Noortje, de Jong, Jeroen R, Vlaeyen, Johan W S, Smeets, Rob J E M, Goossens, Mariëlle E J B
Format: Journal Article
Language:English
Published: England 01-01-2018
Subjects:
Adult
Age Factors
Cognitive Behavioral Therapy - economics
Cognitive Behavioral Therapy - methods
Complex Regional Pain Syndromes - rehabilitation
Complex Regional Pain Syndromes - therapy
Cost of Illness
Cost-Benefit Analysis
Female
Health Expenditures - statistics & numerical data
Humans
Male
Middle Aged
Models, Econometric
Pain Management - economics
Pain Management - methods
Physical Therapy Modalities - economics
Quality of Life
Sex Factors
Socioeconomic Factors
Cost-effectiveness analysis
Exposure in vivo
CRPS-I
Rehabilitation
Pain-related fear
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Summary:The aim of this study was to evaluate the cost-effectiveness of exposure in vivo (EXP, a cognitive-behavioral treatment targeting pain-related fear) in Complex Regional Pain Syndrome Type I (CRPS-I), as compared to pain-contingent physical therapy (PPT). Data from a randomized controlled trial were used to compare the cost-effectiveness of EXP versus PPT from a societal perspective. Intervention costs, other healthcare costs, costs to patient and family, and productivity losses were included. The main outcomes were changes in the SF-36 physical component scale and quality-adjusted life-years. Changes were followed until 6 months after treatment. Uncertainty was estimated using nonparametric bootstrap analysis, cost-effectiveness acceptability curves and cost-effectiveness planes. Sensitivity analyses were performed to check robustness of findings. Forty-six patients were randomized and thirty-eight completed the study. Over 6 months, EXP resulted in greater improvement in physical health-related quality of life and quality-adjusted life-years than PPT. Despite higher initial treatment costs, EXP showed a tendency to reduce all costs compared with PPT; healthcare costs were significantly reduced. Furthermore, the cost-effectiveness planes were in favor of EXP. Sensitivity analyses, for different program costs and complete cases only, confirmed robustness of these findings. EXP, a cognitive-behavioral treatment, seems more cost-effective than PPT in CRPS patients with pain-related fear. The initial higher costs for EXP are offset by a long-term reduction of costs for healthcare use, and a tendency to lower work absenteeism and reduced societal costs. Due to low sample sizes, replication of findings is required to confirm results.
ISSN:1471-6348
DOI:10.1017/S0266462318000429