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Cost effectiveness of combined spa-exercise therapy in ankylosing spondylitis: a randomized controlled trial.
Arthritis Rheum. 2002 Oct 15; 47(5):459-67.AR

Abstract

OBJECTIVE

To evaluate the cost effectiveness and cost utility of a 3-week course of combined spa therapy and exercise therapy in addition to standard treatment consisting of antiinflammatory drugs and weekly group physical therapy in ankylosing spondylitis (AS) patients.

METHODS

A total of 120 Dutch outpatients with AS were randomly allocated into 3 groups of 40 patients each. Group 1 was treated in a spa resort in Bad Hofgastein, Austria; group 2 in a spa resort in Arcen, The Netherlands. The control group stayed at home and continued their usual activities and standard treatment during the intervention weeks. After the intervention, all patients followed weekly group physical therapy. The total study period was 40 weeks. Effectiveness of the intervention was assessed by functional ability using the Bath Ankylosing Spondylitis Function Index (BASFI). Utilities were measured with the EuroQoL (EQ-5D(utility)). A time-integrated summary score defined the clinical effects (BASFI-area under the curve [AUC]) and utilities (EQ-5D(utility)-AUC) over time. Both direct (health care and non-health care) and indirect costs were included. Resource utilization and absence from work were registered weekly by the patients in a diary. All costs were calculated from a societal perspective.

RESULTS

A total of 111 patients completed the diary. The between-group difference for the BASFI-AUC was 1.0 (95% confidence interval [95% CI] 0.4-1.6; P = 0.001) for group 1 versus controls, and 0.6 (95% CI 0.1-1.1; P = 0.020) for group 2 versus controls. The between-group difference for EQ-5D(utility)-AUC was 0.17 (95% CI 0.09-0.25; P < 0.001) for group 1 versus controls, and 0.08 (95% CI 0.00-0.15; P = 0.04) for group 2 versus controls. The mean total costs per patient (including costs for spa therapy) in Euros (euro;) during the study period were euro;3,023 for group 1, euro;3,240 for group 2, and euro;1,754 for the control group. The incremental cost-effectiveness ratio per unit effect gained in functional ability (0-10 scale) was euro;1,269 (95% CI 497-3,316) for group 1, and euro;2,477 (95% CI 601-12,098) for group 2. The costs per quality-adjusted life year gained were euro;7,465 (95% CI 3,294-14,686) for group 1, and euro;18,575 (95% CI 3,678-114,257) for group 2.

CONCLUSION

Combined spa-exercise therapy besides standard treatment with drugs and weekly group physical therapy is more effective and shows favorable cost-effectiveness and cost-utility ratios compared with standard treatment alone in patients with AS.

Authors+Show Affiliations

University Hospital Maastricht, Maastricht, The Netherlands. avantubergen@yahoo.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

12382292

Citation

Van Tubergen, Astrid, et al. "Cost Effectiveness of Combined Spa-exercise Therapy in Ankylosing Spondylitis: a Randomized Controlled Trial." Arthritis and Rheumatism, vol. 47, no. 5, 2002, pp. 459-67.
Van Tubergen A, Boonen A, Landewé R, et al. Cost effectiveness of combined spa-exercise therapy in ankylosing spondylitis: a randomized controlled trial. Arthritis Rheum. 2002;47(5):459-67.
Van Tubergen, A., Boonen, A., Landewé, R., Rutten-Van Mölken, M., Van Der Heijde, D., Hidding, A., & Van Der Linden, S. (2002). Cost effectiveness of combined spa-exercise therapy in ankylosing spondylitis: a randomized controlled trial. Arthritis and Rheumatism, 47(5), 459-67.
Van Tubergen A, et al. Cost Effectiveness of Combined Spa-exercise Therapy in Ankylosing Spondylitis: a Randomized Controlled Trial. Arthritis Rheum. 2002 Oct 15;47(5):459-67. PubMed PMID: 12382292.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost effectiveness of combined spa-exercise therapy in ankylosing spondylitis: a randomized controlled trial. AU - Van Tubergen,Astrid, AU - Boonen,Annelies, AU - Landewé,Robert, AU - Rutten-Van Mölken,Maureen, AU - Van Der Heijde,Désirée, AU - Hidding,Alita, AU - Van Der Linden,Sjef, PY - 2002/10/17/pubmed PY - 2002/11/26/medline PY - 2002/10/17/entrez SP - 459 EP - 67 JF - Arthritis and rheumatism JO - Arthritis Rheum VL - 47 IS - 5 N2 - OBJECTIVE: To evaluate the cost effectiveness and cost utility of a 3-week course of combined spa therapy and exercise therapy in addition to standard treatment consisting of antiinflammatory drugs and weekly group physical therapy in ankylosing spondylitis (AS) patients. METHODS: A total of 120 Dutch outpatients with AS were randomly allocated into 3 groups of 40 patients each. Group 1 was treated in a spa resort in Bad Hofgastein, Austria; group 2 in a spa resort in Arcen, The Netherlands. The control group stayed at home and continued their usual activities and standard treatment during the intervention weeks. After the intervention, all patients followed weekly group physical therapy. The total study period was 40 weeks. Effectiveness of the intervention was assessed by functional ability using the Bath Ankylosing Spondylitis Function Index (BASFI). Utilities were measured with the EuroQoL (EQ-5D(utility)). A time-integrated summary score defined the clinical effects (BASFI-area under the curve [AUC]) and utilities (EQ-5D(utility)-AUC) over time. Both direct (health care and non-health care) and indirect costs were included. Resource utilization and absence from work were registered weekly by the patients in a diary. All costs were calculated from a societal perspective. RESULTS: A total of 111 patients completed the diary. The between-group difference for the BASFI-AUC was 1.0 (95% confidence interval [95% CI] 0.4-1.6; P = 0.001) for group 1 versus controls, and 0.6 (95% CI 0.1-1.1; P = 0.020) for group 2 versus controls. The between-group difference for EQ-5D(utility)-AUC was 0.17 (95% CI 0.09-0.25; P < 0.001) for group 1 versus controls, and 0.08 (95% CI 0.00-0.15; P = 0.04) for group 2 versus controls. The mean total costs per patient (including costs for spa therapy) in Euros (euro;) during the study period were euro;3,023 for group 1, euro;3,240 for group 2, and euro;1,754 for the control group. The incremental cost-effectiveness ratio per unit effect gained in functional ability (0-10 scale) was euro;1,269 (95% CI 497-3,316) for group 1, and euro;2,477 (95% CI 601-12,098) for group 2. The costs per quality-adjusted life year gained were euro;7,465 (95% CI 3,294-14,686) for group 1, and euro;18,575 (95% CI 3,678-114,257) for group 2. CONCLUSION: Combined spa-exercise therapy besides standard treatment with drugs and weekly group physical therapy is more effective and shows favorable cost-effectiveness and cost-utility ratios compared with standard treatment alone in patients with AS. SN - 0004-3591 UR - https://www.unboundmedicine.com/medline/citation/12382292/Cost_effectiveness_of_combined_spa_exercise_therapy_in_ankylosing_spondylitis:_a_randomized_controlled_trial_ L2 - https://doi.org/10.1002/art.10658 DB - PRIME DP - Unbound Medicine ER -