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Clinical and cost-effectiveness analysis of telerehabilitation intervention for people with nonspecific chronic low back pain (Preprint)

Fatoye, Francis and Gebrye, Tadesse and Fatoye, Clara and Mbada, Chidozie E and Olaoye, Mistura I and Odole, Adesola C and Dada, Olumide O (2020) Clinical and cost-effectiveness analysis of telerehabilitation intervention for people with nonspecific chronic low back pain (Preprint). JMIR mHealth and uHealth.

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Abstract

Physiotherapy is the main stay management strategy for nonspecific chronic low back pain (NCLBP), however, its availability in resource-limited countries can be challenging. Therefore, telerehabilitation may be a potential management strategy for NCLBP in resource-limited countries. Objective: This study evaluated the clinical and cost-effectiveness of a telerehabilitation compared to clinic-based intervention for people with NCLBP in Nigeria. Methods: A cost-utility analysis alongside a randomised controlled trial from a healthcare perspective was conducted. Patients with NCLBP were assigned into either telerehabilitation (TG) or clinic-based intervention group (CBIG). Interventions were carried out three times weekly for a period of eight weeks. Patients’ level of disability was measured using Oswestry Disability Index (ODI) at baseline, week 4 and week 8. In order to estimate the health related quality of life of patients used for cost-effectiveness analysis the ODI was mapped to SF-6D to generate quality adjusted life years (QALYs). Healthcare resource use questionnaire was administered to assess the costs of interventions after 8 weeks. Descriptive and inferential data analyses were also performed to assess the clinical effectiveness of the interventions. The incremental cost effectiveness ratio (ICER) was calculated. The effect of changing the values of some variables on the ICER were examined by sensitivity analysis. Results: A total of 47 patients (TG, n = 21; CBIG, n = 26) with the mean (± SD) age of 47± (11.62) years for telerehabilitation and 50 ± (10.67) years for clinic-based intervention participated in this study. The mean costs estimate of telerehabilitation and clinic-based interventions per person per year were N22, 200.00 ($61.70) and 38,200.00 ($106.22), respectively. QALY gained was 0.13 for the TG and 0.11 for the CBIG. The TG arm was associated with an extra of 0.02 QALYs [95% CI -0.01, 0.03] per participant compared to the CBIG arm. Thus, the ICER for TG was –N800,000 (-$2,213.0)/QALY gained. The incremental cost and effectiveness of TBMT by half of the base case values led to a 1/3 reduction of the ICER. Conclusions: The findings of the study suggested that telerehabilitation is cost-effective and cost saving. Given the small number of participants in this study, further examination of effects and costs of the interventions are needed within a larger sample size. In addition, future studies are required to assess the cost-effectiveness of this intervention in the longer-term from patient and societal perspective. Clinical Trial: Registration number.: IPH/OAU/12/515

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