Cost-effectiveness of stratified physiotherapy integrated with digital health versus usual physiotherapy for neck and/or shoulder pain: results of a cluster randomised clinical trial.

Abstract

To evaluate the cost-effectiveness of a Stratified Blended Physiotherapy Approach (SBPA), combining prognostic risk stratification with digital health, compared to usual physiotherapy for patients with neck and/or shoulder pain. Economic evaluation alongside a multicentre, pragmatic, two-arm, parallel-group cluster randomized clinical trial. Primary care physiotherapy practices across the Netherlands. 139 patients (≥18 years) with neck and/or shoulder pain were recruited from 24 practices, 136 were analysed. SBPA combined risk stratification and assessment of suitability for blended care to provide matched physiotherapy integrating either an app or paper-based workbook. Usual physiotherapy followed clinical guidelines without stratification or digital support. Health outcomes were QALYs, measured using the EQ-5D-5L over 9 months, and region-specific pain and disability. Analyses adopted a societal (primary) and a healthcare perspective (secondary). From a societal perspective, SBPA was associated with an incremental cost of €175 (95% CI: -€1 284 to €2 558) and a QALY difference of 0.001 (95% CI: -0.01 to 0.01), with an ICER of €221 123/QALY and 0.43 probability of cost-effectiveness at €0/QALY. From the healthcare perspective, SBPA reduced costs by €47 (95% CI: -€142 to €47) with a QALY difference of 0.001 (95% CI: -0.01 to 0.01), yielding a 0.83 probability of cost-effectiveness at €0/QALY. SBPA showed no clear cost-effectiveness from a societal perspective compared to usual physiotherapy. From a healthcare perspective, SBPA showed a higher probability of cost-effectiveness, although differences in costs and effects were small and uncertain. Further research should explore alternative or supplementary strategies to and beyond risk stratification and blended care to optimize physiotherapy care for people with neck and/or shoulder pain. NL-OMON52723 (Registered 27 December 2019; first enrolment: 30 September 2020).