PAIN+ CPN

OBJECTIVE: To evaluate the cost-effectiveness of a stratified blended physiotherapy approach (SBPA), combining prognostic risk stratification with digital health, compared with usual physiotherapy for patients with neck and/or shoulder pain.

DESIGN: Economic evaluation of a multicenter, pragmatic, 2-arm, parallel-group cluster-randomized controlled trial.

SETTING: Primary care physiotherapy practices across the Netherlands.

PARTICIPANTS: 139 patients (N=139) (=18y) with neck and/or shoulder pain were recruited from 24 practices; 136 were analyzed.

INTERVENTIONS: SBPA combined risk stratification with an assessment of suitability for blended care to provide matched physiotherapy integrating either an application or a paper-based workbook. Usual physiotherapy followed clinical guidelines without stratification or digital support.

MAIN OUTCOME MEASURES: Health outcomes were quality-adjusted life years (QALYs), measured using the EuroQol 5-Dimension 5-Level questionnaire over 9 months, and region-specific pain and disability. Analyses adopted a societal (primary) and a health care perspective (secondary).

RESULTS: From a societal perspective, SBPA was associated with an incremental cost of €175 (95% CI, -€1284 to €2558) and a QALY difference of 0.001 (95% CI, -0.01 to 0.01), with an incremental cost-effectiveness ratio of €221,123/QALY and a 0.43 probability of cost-effectiveness at €0/QALY. From a health care 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.

CONCLUSIONS: SBPA showed no clear cost-effectiveness from a societal perspective compared with usual physiotherapy. From a health care 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 beyond risk stratification and blended care to optimize physiotherapy care for people with neck and/or shoulder pain.

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