Cost effectiveness of group physical therapy compared to individualized therapy for ankylosing spondylitis. A randomized controlled trial

Abstract

Objective: Cost effectiveness analysis is helpful in setting priorities for funding of health care programs. We studied the cost effectiveness of supervised group physical therapy compared to unsupervised exercises at home in patients with ankylosing spondylitis (AS).

Methods: A total of 144 patients with AS (modified New York criteria; mean age: 43 years) were randomized to unsupervised daily individualized exercises at home for 9 months or the same plus supervised group physical therapy (3 h weekly). At baseline and after 9 months we measured spinal mobility (thoracolumbar flexion and extension), fitness (maximum work capacity by ergometry), and patient's global assessment of change as measured on a visual analog scale. We used a questionnaire at baseline and a diary during the trial to measure AS related direct medical costs, such as doctor visits, paramedical treatment, medication and hospitalization.

Results: The mean effects of group therapy and home exercises were, respectively, +0.9 cm (16%) and +0.5 cm (9%) for mobility, +7 watts (4%) and -2 watts (-1%) for fitness, and +1.7 (34%) and +0.3 (6%) for global health. These 3 differences were significant (p < 0.01 for mobility, p = 0.05 for fitness and p < 0.01 for global health). During the trial total medical costs decreased by an average of US $379 (44%) for group therapy, and by $257 (35%)/patient/year for the "home" group. Additional costs of group therapy were estimated at $531/patient/year ($177 for accommodation, $256 for therapist and $98 for materials). After the study 75% of the patients wanted to continue group physical therapy and were willing to pay for it.

Conclusion: Compared to therapy at home, additional benefits of group therapy cost $531/year, but reduced direct medical costs by $122/year. Hence, the beneficial effects of group therapy cost $409/patient with AS/year.