A Cost-efficiency Analysis of Physiotherapist or Physicians as Primary Assessors for Patients With Knee Pain in Primary Care
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 363
- 试验地点
- 9
- 主要终点
- Incremental Cost-effectiveness Ratio (ICER) - Societal Perspective
研究概览
简要总结
Background: Almost half of the Swedish population are overweight or obese. This will probably affect the incidence of osteoarthritis since overweight is a strong risk factor. Osteoarthritis consultations is expected to increase with 30-50% within the next 20 years. Today, in Swedish primary care, both physicians and physiotherapists are primary assessors for patients with suspected knee osteoarthritis. A task shifting with physiotherapists as the only primary assessor could increase the access rate to physicians in primary care for patients with more severe disorders. Yet, it is unclear what effects these different healthcare processes have and the costs of it.
Purpose: The overall purpose of this study is to perform an economic evaluation of two healthcare processes, where a healthcare process initiated by a physiotherapist is compared with when it is initiated with a physician for patients with suspected knee osteoarthritis.
Methods: 100 patients will be randomized either to a physiotherapists or to a physician for first assessment, diagnosis and treatment. Measurements of health-related quality of life and costs for visits to physiotherapists, physician or other healthcare provider, drug prescriptions and sick-leave will be collected. A cost-effectiveness analysis will be conducted, presenting incremental cost-effectiveness ratio (ICER) and a non-parametric bootstrapping will be conducted to demonstrate the uncertainties surrounding the ICER.
Expected results: It is expected that this randomized controlled study will show the effects on quality adjusted life years, cost-efficiency and cost-utility of two different primary assessors for patients with suspected knee osteoarthritis consulting primary care. The results could clarify which profession that is most appropriate to be the primary assessor for patients with suspected knee osteoarthritis in primary care.
详细描述
Problem statements:
What is the difference in cost efficiency between a healthcare process with a physiotherapists as primary assessor and a physician as primary assessor for patients with suspected knee osteoarthritis?
Which effect does a clinical pathway with a physiotherapists as primary assessor for patients with suspected knee osteoarthritis have on quality adjusted life years compared with a physician as primary assessor?
What are the differences in costs between the two healthcare processes initiated by either a physiotherapist or a physician set against the differences in effects?
Patient recruitment:
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Outcomes Assessor)
入排标准
- 年龄范围
- 38 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Knee pain most of the days the last month
- •Over 38 years old
- •Crepitus on active motion
- •Morning stiffness less than 30 minutes
排除标准
- •Not been diagnosed for current knee pain
- •Non-traumatic cause due to current knee pain
- •No other rheumatic, severe somatic or psychological diseases that can affect the outcome measures.
- •Not pregnant
- •Does not know enough Swedish to answer questionnaires.
结局指标
主要结局
Incremental Cost-effectiveness Ratio (ICER) - Societal Perspective
时间窗: 12 months
Mean difference in costs divided by mean difference in quality adjusted life years (QALYs). Presenting the results of the cost-effectiveness analysis (ICER). Societal perspective includes health care visits, prescribed drugs, productivity loss and unpaid work compensation Incremental Cost-effectiveness Ratio was derived from the model where a measure of dispersion was not an output of the model
Mean Difference in Total Costs (Societal Perspective)
时间窗: 12 months
Total costs with the societal perspective includes health care visits, prescribed drugs, productivity loss and unpaid work compensation. Data were retrieved from medical records.
Mean Difference in Total Costs (Health Care Perspective)
时间窗: 12 months
Health care perspective includes health care visits and prescribed drugs. Data were collected through medical records.
Mean Difference in Quality Adjusted Life Years (QALY)
时间窗: 12 months
Health-related quality of life was used as the generic measure for health improvement and was measured at baseline, 3-, 6- and 12-month follow-up. The Swedish version of Euroqol-5 dimensions-3 levels (EQ5D-3L) was used to assess perceived self-rated health-related quality of life. The questionnaire contained five dimensions and resulted in an index ranging from -0,549 to 1 using the United Kingdom tariffs. An index of 1 indicate full health. For each participant, EQ-5D-3L index was used when calculating quality adjusted life years (QALY) using linear interpolation between each measurement point and the trapezoidal rule to calculate the "area under the curve". QALY range from 0 to 1, where 0 means death and 1 equals full health.
Incremental Cost-effectiveness Ratio (ICER) - Health Care Perspective
时间窗: 12 months
Mean difference in costs divided by mean difference in quality adjusted life years (QALYs). Presenting the results of the cost-effectiveness analysis (ICER). Health care perspective includes health care visits and prescribed drugs. Incremental Cost-effectiveness Ratio was derived from the model where a measure of dispersion was not an output of the model
次要结局
- Costs for Productivity Loss(12 months)
- Costs for Referrals to Radiography(12 months)
- Costs for Physician Visits(12 months)
- Costs for Collected Prescribed Drugs(12 months)
- Costs for Physiotherapy Visits(12 months)
- Costs for Referrals to Orthopedic Surgeon(12 months)
- Costs for Unpaid Work Compensation(12 months)