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Osteopathic care for low back pain and neck pain : a cost-utility analysis

Nick Verhaeghe (UGent) , Janne Schepers (UGent) , P van Dun and Lieven Annemans (UGent)
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Abstract
Objectives: The aim was to examine the health and economic consequences of osteopathic care for low back pain and neck pain in addition to usual care compared to usual care alone. Design: A decision tree model considering a one-year time horizon was applied. The analysis occurred from a health insurance perspective only considering direct medical costs. The health effects were expressed as quality-adjusted life years (QALYs). Main outcomes: The main outcome was the incremental cost-effectiveness ratio (ICER). The uncertainty around key input parameters was addressed applying one-way and probabilistic sensitivity analyses (5000 simulations). Results: For low back pain, osteopathy resulted in cost savings ((sic)385.1 vs (sic)501.8/patient) at improved QALYs (0.666 vs. 0.614) compared to usual care. For neck pain, osteopathy resulted in additional costs ((sic)577.3 vs. (sic)521.0) and improved QALYs (0.639 vs. 0.609) resulting in an ICER of (sic)1,870/QALY. The one-way sensitivity analysis identified the hospitalization cost (back) and osteopathy cost (neck) as major cost drivers. The probabilistic sensitivity analysis resulted in an average net saving of (sic)163 (95%CI-(sic)260, -(sic)49.1) and a QALY gain of 0.06 (95%CI -0.06, 0.17) for low back pain and an average additional cost of (sic)55.1 (95%CI (sic)20.9, (sic)129) and improved QALY gain of 0.03 (95%CI-0.06, 0.12) for neck pain. Conclusions: Osteopathy was found to be a 'dominant' (low back pain) and cost-effective strategy (neck pain) compared to usual care. Further health economic evaluation studies considering a broader range of cost items and longer time horizon are required.
Keywords
Osteopathy, Cost-utility, Low back, Neck, Pain, RANDOMIZED CONTROLLED-TRIAL, 2000-2010 TASK-FORCE, MANIPULATIVE TREATMENT, MANUAL TREATMENT, CLINICAL-TRIALS, METAANALYSIS, DISABILITY, GUIDELINES, MANAGEMENT, DISORDERS

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Chicago
Verhaeghe, Nick, Janne Schepers, P van Dun, and Lieven Annemans. 2018. “Osteopathic Care for Low Back Pain and Neck Pain : a Cost-utility Analysis.” Complementary Therapies in Medicine 40: 207–213.
APA
Verhaeghe, N., Schepers, J., van Dun, P., & Annemans, L. (2018). Osteopathic care for low back pain and neck pain : a cost-utility analysis. COMPLEMENTARY THERAPIES IN MEDICINE, 40, 207–213.
Vancouver
1.
Verhaeghe N, Schepers J, van Dun P, Annemans L. Osteopathic care for low back pain and neck pain : a cost-utility analysis. COMPLEMENTARY THERAPIES IN MEDICINE. 2018;40:207–13.
MLA
Verhaeghe, Nick, Janne Schepers, P van Dun, et al. “Osteopathic Care for Low Back Pain and Neck Pain : a Cost-utility Analysis.” COMPLEMENTARY THERAPIES IN MEDICINE 40 (2018): 207–213. Print.
@article{8569030,
  abstract     = {Objectives: The aim was to examine the health and economic consequences of osteopathic care for low back pain and neck pain in addition to usual care compared to usual care alone. 
Design: A decision tree model considering a one-year time horizon was applied. The analysis occurred from a health insurance perspective only considering direct medical costs. The health effects were expressed as quality-adjusted life years (QALYs). 
Main outcomes: The main outcome was the incremental cost-effectiveness ratio (ICER). The uncertainty around key input parameters was addressed applying one-way and probabilistic sensitivity analyses (5000 simulations). 
Results: For low back pain, osteopathy resulted in cost savings ((sic)385.1 vs (sic)501.8/patient) at improved QALYs (0.666 vs. 0.614) compared to usual care. For neck pain, osteopathy resulted in additional costs ((sic)577.3 vs. (sic)521.0) and improved QALYs (0.639 vs. 0.609) resulting in an ICER of (sic)1,870/QALY. The one-way sensitivity analysis identified the hospitalization cost (back) and osteopathy cost (neck) as major cost drivers. The probabilistic sensitivity analysis resulted in an average net saving of (sic)163 (95\%CI-(sic)260, -(sic)49.1) and a QALY gain of 0.06 (95\%CI -0.06, 0.17) for low back pain and an average additional cost of (sic)55.1 (95\%CI (sic)20.9, (sic)129) and improved QALY gain of 0.03 (95\%CI-0.06, 0.12) for neck pain. 
Conclusions: Osteopathy was found to be a 'dominant' (low back pain) and cost-effective strategy (neck pain) compared to usual care. Further health economic evaluation studies considering a broader range of cost items and longer time horizon are required.},
  author       = {Verhaeghe, Nick and Schepers, Janne and van Dun, P and Annemans, Lieven},
  issn         = {0965-2299},
  journal      = {COMPLEMENTARY THERAPIES IN MEDICINE},
  keyword      = {Osteopathy,Cost-utility,Low back,Neck,Pain,RANDOMIZED CONTROLLED-TRIAL,2000-2010 TASK-FORCE,MANIPULATIVE TREATMENT,MANUAL TREATMENT,CLINICAL-TRIALS,METAANALYSIS,DISABILITY,GUIDELINES,MANAGEMENT,DISORDERS},
  language     = {eng},
  pages        = {207--213},
  title        = {Osteopathic care for low back pain and neck pain : a cost-utility analysis},
  url          = {http://dx.doi.org/10.1016/j.ctim.2018.06.001},
  volume       = {40},
  year         = {2018},
}

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