Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Feb 8;21(1):14.
doi: 10.1186/s12962-022-00410-y.

Economic costs, health-related quality of life outcomes and cost-utility of a physical and psychological group intervention targeted at older adults with neurogenic claudication

Mandy Maredza  1 , Kamran Khan  2 , Ioana R Marian  3 , Susan J Dutton  3 , Esther Williamson  3   4 , Sarah E Lamb  4 , Stavros Petrou  5
Affiliations

Economic costs, health-related quality of life outcomes and cost-utility of a physical and psychological group intervention targeted at older adults with neurogenic claudication

Mandy Maredza et al. Cost Eff Resour Alloc. .

Erratum in

Abstract

Background: Emerging evidence suggests that structured and progressive exercise underpinned by a cognitive behavioural approach can improve functional outcomes in patients with neurogenic claudication (NC). However, evidence surrounding its economic benefits is lacking.

Objectives: To estimate the economic costs, health-related quality of life outcomes and cost-effectiveness of a physical and psychological group intervention (BOOST programme) versus best practice advice (BPA) in older adults with NC.

Methods: An economic evaluation was conducted based on data from a pragmatic, multicentre, superiority, randomised controlled trial. The base-case economic evaluation took the form of an intention-to-treat analysis conducted from a UK National Health Service (NHS) and personal social services (PSS) perspective and separately from a societal perspective. Costs (£ 2018-2019 prices) were collected prospectively over a 12 month follow-up period. A bivariate regression of costs and quality-adjusted life-years (QALYs), with multiple imputation of missing data, was conducted to estimate the incremental cost per QALY gained and the incremental net monetary benefit (INMB) of the BOOST programme in comparison to BPA. Sensitivity and pre-specified subgroup analyses explored uncertainty and heterogeneity in cost-effectiveness estimates.

Results: Participants (N = 435) were randomised to the BOOST programme (n = 292) or BPA (n = 143). Mean (standard error [SE]) NHS and PSS costs over 12 months were £1,974 (£118) in the BOOST arm versus £1,827 (£169) in the BPA arm (p = 0.474). Mean (SE) QALY estimates were 0.620 (0.009) versus 0.599 (0.006), respectively (p = 0.093). The probability that the BOOST programme is cost-effective ranged between 67 and 83% (NHS and PSS perspective) and 79-89% (societal perspective) at cost-effectiveness thresholds between £15,000 and £30,000 per QALY gained. INMBs ranged between £145 and £464 at similar cost-effectiveness thresholds. The cost-effectiveness results remained robust to sensitivity analyses.

Conclusions: The BOOST programme resulted in modest QALY gains over the 12 month follow-up period. Future studies with longer intervention and follow-up periods are needed to address uncertainty around the health-related quality of life impacts and cost-effectiveness of such programmes. Trial registration This study has been registered in the International Standard Randomised Controlled Trial Number registry, reference number ISRCTN12698674. Registered on 10 November 2015.

Keywords: Cost-effectiveness; Economic costs; Exercise; Health-related quality of life; Neurogenic claudication; Psychosocial; Rehabilitation; Spinal stenosis.

PubMed Disclaimer

Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Cost-effectiveness plane for the base case imputed covariate-adjusted analysis
Fig. 2
Fig. 2
Cost-effectiveness acceptability curve for the base-case imputed (covariate -adjusted) analysis
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Zaina F, Tomkins-Lane C, Carragee E, Negrini S. Surgical versus nonsurgical treatment for lumbar spinal stenosis. Spine. 2016;41:E857–e868. doi: 10.1097/BRS.0000000000001635. - DOI - PubMed
    1. Ammendolia C, Stuber KJ, Rok E, Rampersaud R, Kennedy CA, Pennick V, Steenstra IA, de Bruin LK, Furlan AD. Nonoperative treatment for lumbar spinal stenosis with neurogenic claudication. Cochrane Database Syst Rev. 2013 doi: 10.1002/14651858.CD010712. - DOI - PMC - PubMed
    1. Ammendolia C, Côté P, Southerst D, Schneider M, Budgell B, Bombardier C, Hawker G, Rampersaud YR. Comprehensive nonsurgical treatment versus self-directed care to improve walking ability in lumbar spinal stenosis: a randomized trial. Arch Phys Med Rehabil. 2018;99:2408–2419.e2402. doi: 10.1016/j.apmr.2018.05.014. - DOI - PubMed
    1. Minetama M, Kawakami M, Teraguchi M, Kagotani R, Mera Y, Sumiya T, Nakagawa M, Yamamoto Y, Matsuo S, Sakon N, et al. Supervised physical therapy versus unsupervised exercise for patients with lumbar spinal stenosis: 1-year follow-up of a randomized controlled trial. Clin Rehabil. 2021;35:964–975. doi: 10.1177/0269215520986688. - DOI - PubMed
    1. Khan I, Petrou S, Khan K, Mistry D, Lall R, Sheehan B, Lamb S. Does structured exercise improve cognitive impairment in people with mild to moderate dementia? a cost-effectiveness analysis from a confirmatory randomised controlled trial: the dementia and physical activity (DAPA) trial. Pharmaco Economics Open. 2019;3:215–227. doi: 10.1007/s41669-018-0097-9. - DOI - PMC - PubMed

Associated data

LinkOut - more resources