scholarly journals Cost-effectiveness analysis of a chronic back pain multidisciplinary biopsychosocial rehabilitation (MBR) compared to standard care for privately insured in Germany

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
M. Hochheim ◽  
P. Ramm ◽  
M. Wunderlich ◽  
V. Amelung
Keyword(s):  
Back Pain ◽  
Cost Effectiveness ◽  
Sick Leave ◽  
Controlled Trial ◽  
Cost Effective ◽  
Health Related Quality ◽  
Effectiveness Analysis ◽  
Related Quality ◽  
Health Related

Abstract Background Multidisciplinary biopsychosocial rehabilitation (MBR) is highly recommended for chronic lower back pain (CLBP) treatment, but its economic benefit remains to be clearly demonstrated. The purpose of this study is to analyse the effect of a 12-month MBR programme of behavioural change coaching and device-supported exercise on direct medical costs, sick leave and health-related quality of life (HRQOL) at 24 months. Methods An incremental cost-effectiveness analysis was conducted in Germany from a private health insurance perspective using data from a multi-centre, two-arm randomised controlled trial with parallel-group Zelen's randomisation and 24-month follow-up. After removing dissimilarities in characteristics between MBR and usual care (control) via propensity score matching, treatment effects were calculated using a difference-in-difference approach. Results Base-case analysis of the MBR (n=112) and usual care group (n=111) showed an incremental cost-effectiveness ratio (ICER) of €8,296 per quality-adjusted life year (QALY) gained, indicating that the intervention was cost-effective. Compared to the controls, MBR reduced economically unaccounted sick leave due to back pain in the last six months by 17.5 days (p = 0.001) and had a positive effect on health-related quality of life (HRQOL) (0.046, p=0.026). Subgroup analysis of participants with major impairment demonstrated that a dominant intervention was possible, as reflected by an ICER of - €7,302 per QALY. Savings were driven by a - €1,824 reduction in back pain-specific costs. Moreover, sick leave was 27 days (p = 0.006) less in the MBR group. Conclusions This first cost-effectiveness study with combined data from a private health insurer and a controlled trial in Germany demonstrated that long term MBR for the treatment of CLBP is cost-effective. Subgroups with major impairment from back pain benefitted more from the intervention than those with minor impairment. MBR significantly reduced sick leave in all participants. Hence, it is a profitable intervention from a societal point of view. Trial registration The trial of the evaluation study was retrospectively registered in the German Clinical Trials Register under trial number DRKS00015463 retrospectively (dated 4 Sept 2018).

scholarly journals Use, cost-effectiveness, and end user perspectives of a home solar lighting intervention in rural Uganda: a mixed methods, randomized controlled trial

2021 ◽  
Author(s):  
Radhika Sundararajan ◽  
Helen D'Couto ◽  
Joseph Mugerwa ◽  
Mellon Tayebwa ◽  
Nicholas Lam ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Controlled Trial ◽  
Cost Effective ◽  
Health Related Quality ◽  
Lighting System ◽  
Randomized Controlled ◽  
Related Quality ◽  
Health Related ◽  
Solar Lighting

Abstract Energy poverty is prevalent in resource-limited settings, leading households to use inefficient fuels and appliances that contribute to household air pollution. Randomized controlled trials of household energy interventions in low and middle income countries have largely focused on cooking services. Less is known about the adoption and impact of clean lighting interventions. We conducted an explanatory sequential mixed methods study as part of a randomized controlled trial of home solar lighting systems in rural Uganda in order to identify contextual factors determining the use and impact of the solar lighting intervention. We used sensors to track usage, longitudinally assessed household lighting expenditures and health-related quality of life, and performed cost-effectiveness analyses. Qualitative interviews were conducted with all 80 trial participants and coded using reflexive thematic analysis. Uptake of the intervention solar lighting system was high with daily use averaging 8.23 ± 5.30 hours per day. The intervention solar lighting system increased the EQ5D index by 0.025 [95% CI 0.002 - 0.048] and led to an average monthly reduction in household lighting costs by -1.28 [-2.52, -0.85] US dollars, with higher savings in users of fuel-based lighting. The incremental cost-effectiveness ratio for the solar lighting intervention was $2025.72 US dollars per quality adjusted life year (QALY) gained making the intervention cost-effective when benchmarked against the gross domestic product (GDP) per capita in Uganda. Thematic analysis of qualitative data from individual interviews showed that solar lighting was transformative and associated with numerous benefits that fit within a Social Determinants of Health (SDOH) framework. The benefits included improved household finances, improved educational performance of children, increased household safety, improved family and community cohesion, and improved perceived household health. Our findings suggest that household solar lighting interventions may be a cost-effective approach to improve health-related quality of life by addressing SDOH.

scholarly journals Health-related quality of life measures for a cost-effectiveness analysis of ischemic stroke therapies

Kontakt ◽  
2020 ◽  
Vol 22 (2) ◽  
pp. 128-136 ◽  
Author(s):  
Irena Drugdová ◽  
Vladimír Rogalewicz ◽  
Martin Šrámek ◽  
Veronika Kopalová ◽  
Ondřej Krahula ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Ischemic Stroke ◽  
Cost Effectiveness ◽  
Cost Effectiveness Analysis ◽  
Health Related Quality ◽  
Quality Of Life Measures ◽  
Effectiveness Analysis ◽  
Related Quality ◽  
Health Related

scholarly journals Yoga for older adults with multimorbidity (the Gentle Years Yoga Trial): study protocol for a randomised controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Garry A. Tew ◽  
Laura Bissell ◽  
Belen Corbacho ◽  
Caroline Fairhurst ◽  
Jenny Howsam ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Cost Effectiveness ◽  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Randomised Controlled

Abstract Background Multimorbidity is common in older adults and associated with high levels of illness burden and healthcare expenditure. The evidence base for how to manage older adults with multimorbidity is weak. Yoga might be a useful intervention because it has the potential to improve health-related quality of life, physical functioning, and several medical conditions. The British Wheel of Yoga’s Gentle Years Yoga© (GYY) programme was developed specifically for older adults, including those with chronic medical conditions. Data from a pilot trial suggested feasibility of using GYY in this population, but its effectiveness and cost-effectiveness remain uncertain. Methods This is a multi-site, individually randomised, superiority trial with an embedded process evaluation and an economic analysis of cost-effectiveness. The trial will compare an experimental strategy of offering a 12-week GYY programme against a control strategy of no offer in community-dwelling adults aged 65 or over who have multimorbidity, defined as having two or more chronic conditions from a predefined list. The primary outcome is health-related quality of life measured using the EQ-5D-5L, the primary endpoint being the overall difference over 12 months. Both groups will continue to be able to access their usual care from primary, secondary, community, and social services. Participants, care providers, and yoga teachers will not be blinded to the allocated intervention. Outcome measures are primarily self-reported. The analysis will follow intention-to-treat principles. Discussion This pragmatic randomised controlled trial will demonstrate if the GYY programme is an effective, cost-effective, and viable addition to the management of older adults with multimorbidity. Trial registration ISRCTN ISRCTN13567538. Registered on 18 March 2019

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