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EXPOSURE IN VIVO VERSUS PAIN-CONTINGENT PHYSICAL THERAPY IN COMPLEX REGIONAL PAIN SYNDROME TYPE I: A COST-EFFECTIVENESS ANALYSIS

Published online by Cambridge University Press:  26 July 2018

Marlies den Hollander ,
Noortje Heijnders ,
Jeroen R. de Jong ,
Johan W.S. Vlaeyen ,
Rob J.E.M. Smeets  and
Mariëlle E.J.B. Goossens
Marlies den Hollander
Affiliation:
Department of Clinical Psychological Science, Maastricht University Department of Rehabilitation, Maastricht University Medical Center Adelante Centre of Expertise in Rehabilitationmarlies.denhollander@maastrichtuniversity.nl
Noortje Heijnders
Affiliation:
Adelante Centre of Expertise in Rehabilitation
Jeroen R. de Jong
Affiliation:
Department of Rehabilitation, Maastricht University Medical Center Adelante Centre of Expertise in Rehabilitation CAPHRI - School for Public Health and Primary Care, Department of Rehabilitation Medicine, Maastricht University
Johan W.S. Vlaeyen
Affiliation:
Department of Clinical Psychological Science, Maastricht University Research Group Health Psychology, KU Leuven –University of Leuven
Rob J.E.M. Smeets
Affiliation:
CAPHRI - School for Public Health and Primary Care, Department of Rehabilitation Medicine, Maastricht University Libra Rehabilitation and Audiology, Eindhoven/Weert
Mariëlle E.J.B. Goossens
Affiliation:
Department of Clinical Psychological Science, Maastricht University CAPHRI - School for Public Health and Primary Care, Department of Rehabilitation Medicine, Maastricht University
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Abstract

Objectives:

The aim of this study was to evaluate the cost-effectiveness of exposure in vivo (EXP, a cognitive-behavioral treatment targeting pain-related fear) in Complex Regional Pain Syndrome Type I (CRPS-I), as compared to pain-contingent physical therapy (PPT).

Methods:

Data from a randomized controlled trial were used to compare the cost-effectiveness of EXP versus PPT from a societal perspective. Intervention costs, other healthcare costs, costs to patient and family, and productivity losses were included. The main outcomes were changes in the SF-36 physical component scale and quality-adjusted life-years. Changes were followed until 6 months after treatment. Uncertainty was estimated using nonparametric bootstrap analysis, cost-effectiveness acceptability curves and cost-effectiveness planes. Sensitivity analyses were performed to check robustness of findings.

Results:

Forty-six patients were randomized and thirty-eight completed the study. Over 6 months, EXP resulted in greater improvement in physical health-related quality of life and quality-adjusted life-years than PPT. Despite higher initial treatment costs, EXP showed a tendency to reduce all costs compared with PPT; healthcare costs were significantly reduced. Furthermore, the cost-effectiveness planes were in favor of EXP. Sensitivity analyses, for different program costs and complete cases only, confirmed robustness of these findings.

Conclusions:

EXP, a cognitive-behavioral treatment, seems more cost-effective than PPT in CRPS patients with pain-related fear. The initial higher costs for EXP are offset by a long-term reduction of costs for healthcare use, and a tendency to lower work absenteeism and reduced societal costs. Due to low sample sizes, replication of findings is required to confirm results.

Keywords

CRPS-ICost-effectiveness analysisPain-related fearExposure in vivoRehabilitation
Type
Assessment
Information
International Journal of Technology Assessment in Health Care , Volume 34 , Issue 4 , 2018 , pp. 400 - 409
Copyright
Copyright © Cambridge University Press 2018 

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Footnotes

We are grateful for the support of all individuals with CRPS-I who participated in the study, specialists and therapists, our research assistants, referrers to the trial and staff. Ethical standards: The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. Financial support: This work was supported by the Profileringsfonds azM (PF 261); governmental funding for Maastricht University, Faculty of Psychology; the Research Foundation Flanders, Belgium, (J.V., Odysseus Grant G090208N “The Psychology of Pain and Disability Research Program”); and the Flemish Government, Belgium (J.V., “Asthenes” long-term structural funding – Methusalem grant METH/15/011). Funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The study sponsor had no role in the study design, collection, analysis, and interpretation of data, the writing of the report, or in the decision to submit for publication. The corresponding author had full access to all data and final responsibility for the decision to submit for publication.

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