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Table 2 Reported healthcare and PT costs by study

From: Does the implementation of clinical practice guidelines for low back and neck pain by physical therapists improve patient outcomes? A systematic review

Author, year

Healthcare costs

PT costs

Low back pain

 Childs, 2015 [22]

Adherent $2426.88 (SE 30.04)

Nonadherent $2733.57 (SE 26.92)

Difference $306.69 (95% CI 227.63 to 385.75)

Early $1828.24 (SE 15.28)

Delayed $3030.53 (26.64)

Difference $1202.29 (95% CI 1142.09 to 1262.49)

 

 Feuerstein, 2006 [33]

Guideline adherent $222.40

Nonadherent $712.60

(p< .0001), B = −230.10 (95% CI −264.1 to 195.9)

 

 Fritz, 2012 [16]

Adherent:

LBP-related costs were an average $1374.30 lower favoring adherent care vs nonadherent 95% CI 202.28 to 2546.31

 

 Hoeijenbos, 2005 [25]

Mean Direct Medical Costs: Same pattern in the intervention and control group over time: a rapid decrease in the first 12 weeks and after 6 months the healthcare utilization stabilized. Peak consumption 6 weeks

Baseline total direct medical cost: Intervention € 92, median € 72, (SD 62); Control € 89 median € 71, (SD 69)

6 weeks total direct medical cost: Intervention € 125 median € 111, (SD 91) Control € 145 median € 141, (SD 95) P=.026

12 weeks total direct medical cost: Intervention € 58 median € 20, (SD 91), Control € 77 median € 25, (SD 107) P = .051

26 weeks total direct medical cost: Intervention € 33 median € 0, (SD 98), Control € 35, median € 0, (SD 99) P =.818

52 weeks total direct medical cost: Intervention € 24 median € 0, (SD 68), Control € 30, median € 0, (SD 109) P =.477

Increase in costs at 6 weeks and decrease at 12 and 26 weeks were significant within both groups (P< 0.000)

Mean annual direct costs:

Intervention € 374 (SD 427)

Control € 449 (SD 572)

Mean annual productivity costs:

Intervention € 4838 (SD 9572)

Control € 4035 (SD 8962)

Costs per visit:

General practitioner (one visit) € 18.37

Company doctor (one visit) € 18.37

Medical specialist (one visit) € 45.22

1 day in hospital € 261.23

Alpha help per hour € 9.44

Cost-effectiveness of intervention was not calculated due to lack of significant differences, likely extended implementation strategy increases costs

Mean direct medical costs for physiotherapists the previous 6 weeks:

Baseline: Intervention € 54, median € 40; Control € 52, median € 40

6 weeks: Intervention € 106, median; 101 Control € 125 median € 121

12 weeks: Intervention € 51 median € 0.00; Control € 61 median € 0

26 weeks: Intervention € 18 median; € 0 Control € 22 median € 0

52 weeks: Intervention € 15 median; € 0 Control € 19 median € 0

Physiotherapist costs include physiotherapist, manual therapist and Mensendieck or Cesar therapist

Costs per visit:

Physiotherapist (one visit) € 20.10

Physical therapist (one visit) € 19.70

Manual therapist € 30.80

Physiotherapist per hour € 26.42

 Karlen, 2015 [36]

 

Physical Therapy Charges:

2010: Adherent $773, Nonadherent $806

2011: Adherent $815, Nonadherent $861

2012: Adherent $847, Nonadherent $863

2013: Adherent $906, Nonadherent $969

2014: Adherent $896, Nonadherent $976

Increase in charges per LBP episode was 40% lower than the observed rate of inflation for individual units of PT

Acute low back pain

 Fritz, 2007 [17]

 

Adherent $845.57 (SD $449.14)

Nonadherent $884.91 (SD $523.37), P< .001

 Fritz, 2008 [18]

Additional charges for healthcare associated with LBP (1 year after completion of PT): 296 patients (62.8%)

Cost: Mean charges:

Adherent $1692 (SD $7683)

Nonadherent $2829 (SD $21,728, P< .05)

Receiving adherent physical therapy care was associated with a reduced likelihood of incurring high charges for subsequent healthcare. aOR = 0.51 (95% CI 0.31 to 0.87).

Mean overall charges for care (charges for physical therapy+charges for subsequent healthcare):

Adherent: $2255 (SD $7665)

Nonadherent: $3559 (SD $21,720, P< .05)

Adherent physical therapy care: reduced likelihood of incurring high overall charges. aOR = 0.44; (95% CI 0.26 to 0.75).

Adherent $562 (SD 269)

Nonadherent $729 (SD 345) P<.05

 Owens, 2019 [20]

Medical cost (median): $770, range 0–24,327

Total cost (median): $987, range 124–63,992

Each unit increase in ACOEM +1/−1 compliance:

average $352.90 reduction in medical costs (P = .075) and $586.20 reduction in total costs (P = .22)

Expensive outliers were consistent with lower scores, suggesting lower compliance results in higher costs

Statistically significant relationship (P= .0097) between decreasing claim's medical costs and increasing compliance with the ACOEM guidelines when log-transformed to better account for skewed cost distribution and outliers

 

Chronic low back pain

 Van der Roer, 2008 [24]

Direct health care costs: Protocol € 1003 (SD 595), Guideline € 527 (SD 447),

Mean difference € 475, (95% CI 211 to 681)

Direct non-health care costs: Protocol € 82 (SD 233), Guideline € 197 (SD 463)

Mean Difference € −115, (95% CI −220 to 27)

Functional Status (RDQ):

Cost Difference € 233, (95% CI −2185 to 2764)

Effect Difference 0.06, (95% CI −2.22 to 2.34)

Incremental Cost-Effectiveness Ratios (ICER) 16,349

Pain Intensity (PI-NRS):

Cost Difference € 233, (95% CI −2185 to 2764)

Effect Difference −1.02, (95% CI −2.14 to 0.09)

ICER −175

Perceived Recovery (GPE):

Cost Difference € 233, (95% CI −2185 to 2764)

Effect Difference 13%; OR = 1.71, (95% CI 0.67 to 4.38)

ICER 1720

QALYNL (EQ-5D):

Cost Difference € 233, (95% CI −2185 to 2764)

Effect Difference 0.03, (95% CI −0.06 to 0.12)

ICER 5141

Protocol € 779 (SD = 0)

Guideline € 312 (SD = 191)

Mean Difference € 467, (95% CI 298 to 646)

Neck pain

 Horn, 2016 [19]

No significant difference in costs to non-PT health providers. eB = 0.79, 95% CI 0.26 to 2.24; P = .68

Adherent care: 22% lower charges for PT. Mean difference US$ 172.55; eB = 0.78, 95% CI 0.69 to 0.89; P< .001

  1. Bolded indicates statistical significance
  2. PT physical therapy, SE standard error, SD standard deviation, aOR adjusted odds ratio, RDQ Roland Morris Disability Questionnaire, EQ-5D EuroQol-5D, ICER incremental cost-effectiveness ratio