Primary therapist model for patients referred for rheumatoid arthritis rehabilitation: A cost-effectiveness analysis
Article first published online: 31 MAY 2006
Copyright © 2006 by the American College of Rheumatology
Arthritis Care & Research
Volume 55, Issue 3, pages 402–410, 15 June 2006
How to Cite
Li, L. C., Maetzel, A., Davis, A. M., Lineker, S. C., Bombardier, C. and Coyte, P. C. (2006), Primary therapist model for patients referred for rheumatoid arthritis rehabilitation: A cost-effectiveness analysis. Arthritis & Rheumatism, 55: 402–410. doi: 10.1002/art.21989
- Issue published online: 31 MAY 2006
- Article first published online: 31 MAY 2006
- Manuscript Accepted: 18 OCT 2005
- Manuscript Received: 31 JUL 2005
- Canadian Institutes of Health Research (CIHR) Doctoral Research award
- Canadian Arthritis Network Graduate Student award
- CIHR Fellowship award
- Canadian Health Services Research Foundation/CIHR Health Services Chair
- Rheumatoid arthritis;
- Primary therapist model;
- Cost-effectiveness analysis
To estimate the incremental cost-effectiveness (ICE) of services from a primary therapist compared with traditional physical therapists and/or occupational therapists for managing rheumatoid arthritis (RA), from the societal perspective.
Patients with RA were randomly assigned to the primary therapist model (PTM) or traditional treatment model (TTM) for ∼6 weeks of rehabilitation treatment. Health outcomes were expressed in terms of quality-adjusted life years (QALYs), measured with the EuroQol instrument at baseline, 6 weeks, and 6 months. Direct and indirect costs, including visits to health professionals, use of investigative tests, hospital visits, use of medications, purchases of adaptive aids, and productivity losses incurred by patients and their caregivers, were collected monthly.
Of 144 consenting patients, 111 remained in the study after the baseline assessment: 63 PTM (87.3% women, mean age 54.2 years, disease duration 10.6 years) and 48 TTM (79.2% women, mean age 56.8 years, disease duration 13.2 years). From a societal perspective, PTM generated higher QALYs (mean ± SD 0.068 ± 0.22) and resulted in a higher mean cost ($6,848 Canadian, interquartile range [IQR] $1,984–$9,320) compared with TTM (mean ± SD QALY −0.017 ± 0.24; mean costs $6,266, IQR $1,938–$10,194) in 6 months, although differences were not statistically significant. The estimated ICE ratio was $13,700 per QALY gained (95% nonparametric confidence interval −$73,500, $230,000).
The PTM has potential to be an alternative to traditional physical/occupational therapy, although it is premature to recommend widespread use of this model in other regions. Further research should focus on strategies to reduce costs of the model and assess the long-term economic consequences in managing RA and other rheumatologic conditions.