Objectives To evaluate the incremental cost-effectiveness and cost-utility of a 3 weeks course of combined spa-exercise therapy followed by weekly group physical therapy, compared to weekly group physical therapy alone in ankylosing spondylitis (AS) patients.
Methods 120 Dutch AS outpatients were randomly allocated into three groups of 40 patients each. Group 1 was treated at a spa resort in Bad Hofgastein, Austria; group 2 at a spa resort in Arcen, The Netherlands. A control group stayed at home and continued weekly group physical therapy. Spa-exercise therapy consisted of physical exercises, walking, postural correction therapy, hydrotherapy, sports and either visits to the so-called Gasteiner Heilstollen (Austria) or the sauna (The Netherlands). After spa-exercise therapy all patients followed weekly group physical therapy for another 37 weeks. Effectiveness of the intervention was assessed by functional ability (BASFI) (range 0–10). Utilities were measured with the EuroQoL (EQ-5Dutility) (range 0–1). A time-integrated summary score defined the clinical effects (BASFI-AUC) and utilities (EQ-5Dutility-AUC) over time. Both direct (health care and non-health care) and indirect costs were included. Resource utilisation and absence from paid work were registered weekly by the patients in a diary. All costs were calculated from a societal perspective.
Results 111 patients completed the diary (group 1 n = 38; group 2 n = 36; control group n = 37). The between-group difference (95% CI) for the BASFI-AUC was 1.0 (0.4 to 1.6; p = 0.001) for group 1 versus controls, and 0.6 (0.1 to 1.1; p = 0.020) for group 2 versus controls. The between-group difference for the EQ-5Dutility-AUC was 0.17 (0.09 to 0.25; p < 0.001) for group 1 versus controls, and 0.08 (0.00 to 0.15; p = 0.04) for group 2 versus controls. The mean total costs per patient (including costs for spa therapy) during the study period were ?3023 for group 1, ?3240 for group 2, and ?1754 for the control group. The incremental cost-effectiveness ratio was ?1269 per unit effect gained in functional ability for group 1, and ?2477 for group 2. The costs per QALY gained were ?7465 for group 1 and ?18575 for group 2.
Conclusion Combined spa-exercise therapy is more effective and shows favourable cost-effectiveness and cost-utility ratios compared to weekly group physical therapy alone in patients with ankylosing spondylitis.
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