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Randomized Controlled Trial
. 2020 Oct 15;10(10):e035583.
doi: 10.1136/bmjopen-2019-035583.

Cost-effectiveness of internet-based vestibular rehabilitation with and without physiotherapy support for adults aged 50 and older with a chronic vestibular syndrome in general practice

Vincent A van Vugt  1   2 , Judith E Bosmans  2   3 , Aureliano P Finch  2   3 , Johannes C van der Wouden  4   2 , Henriëtte E van der Horst  4   2 , Otto R Maarsingh  4   2
Affiliations
Randomized Controlled Trial

Cost-effectiveness of internet-based vestibular rehabilitation with and without physiotherapy support for adults aged 50 and older with a chronic vestibular syndrome in general practice

Vincent A van Vugt et al. BMJ Open. .

Abstract

Objectives: To evaluate the cost-effectiveness of stand-alone and blended internet-based vestibular rehabilitation (VR) in comparison with usual care (UC) for chronic vestibular syndromes in general practice.

Design: Economic evaluation alongside a three-armed, individually randomised controlled trial.

Setting: 59 Dutch general practices.

Participants: 322 adults, aged 50 years and older with a chronic vestibular syndrome.

Interventions: Stand-alone VR consisted of a 6-week, internet-based intervention with weekly online sessions and daily exercises. In blended VR, this intervention was supplemented with face-to-face physiotherapy support. UC group participants received usual general practice care without restrictions.

Main outcome measures: Societal costs, quality-adjusted life years (QALYs), Vertigo Symptom Scale-Short Form (VSS-SF), clinically relevant response (≥3 points VSS-SF improvement).

Results: Mean societal costs in both the stand-alone and blended VR groups were statistically non-significantly higher than in the UC group (mean difference (MD) €504, 95% CI -1082 to 2268; and €916, 95% CI -663 to 2596). Both stand-alone and blended VR groups reported non-significantly more QALYs than the UC group (MD 0.02, 95% CI -0.00 to 0.04; and 0.01, 95% CI -0.01 to 0.03), and significantly better VSS-SF Scores (MD 3.8 points, 95% CI 1.7 to 6.0; and 3.3 points, 95% CI 1.3 to 5.2). For stand-alone VR compared with UC, the probability of cost-effectiveness was 0.95 at a willingness-to-pay ratio of €24 161/QALY, €600/point improvement in VSS-SF and €8000/clinically relevant responder in VSS-SF. For blended VR versus UC, the probability of cost-effectiveness was 0.95 at a willingness-to-pay ratio of €123 335/QALY, €900/point improvement in VSS-SF and €24 000/clinically relevant responder in VSS-SF.

Conclusion: Stand-alone and blended internet-based VR non-significantly increased QALYs and significantly reduced vestibular symptoms compared with UC, while costs in both groups were non-significantly higher. Stand-alone VR has the highest probability to be cost-effective compared with UC.

Trial registration number: The Netherlands Trial Register NTR5712.

Keywords: health economics; neurology; otolaryngology; primary care; rehabilitation medicine.

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Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form (available on request from the corresponding author) and declare: support from The Netherlands Organisation for Health Research and Development (ZonMw); no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1
Main analysis—societal perspective. Cost-effectiveness acceptability curve for the Vertigo Symptom Scale—Short Form comparing stand-alone VR with usual care. VR, vestibular rehabilitation.
Figure 2
Figure 2
Main analysis—societal perspective. Cost-effectiveness acceptability curve for the Vertigo Symptom Scale—Short Form comparing blended VR with usual care. VR, vestibular rehabilitation.
See this image and copyright information in PMC

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