Cost-effectiveness analysis of adjuvant physical or occupational therapy for patients with reflex sympathetic dystrophy

Objective: To study from a societal viewpoint the cost-effectiveness of adj uvant treatment for patients with reflex sympathetic dystrophy (RSD) of one upper extremity. Design: A two-center randomized clinical trial comparing pairwise physical therapy (PT), occupational therapy (OT), and control treatment (CT). Patients: One hundred thirty-five patients with RSD for less than 1 year pa rticipated. Interventions: PT and OT were given according to protocols. For CT, service s by social workers were offered. Main Outcome Measures: The Impairment-level Sum Score (ISS), the modified G reentest, and the Sickness Impact Profile (STP) were used to determine effe ctiveness. Real medical costs, nonmedical costs, and productivity costs wer e distinguished and incremental cost-effectiveness ratios were calculated. Sensitivity analyses were performed on cost estimates. Results: The ISS, but not the Greentest and SIP, showed a significant diffe rence between PT versus OT and CT. The mean adjuvant treatment costs were s ignificantly higher for PT (Netherlands Guilders [NLG] 1,726) and OT (NLG 2 ,089) compared with CT (NLG 903). The mean total medical costs were not sig nificantly different for the groups (PT, NLG 8,692; OT, NLG 13,023; and CT, NLG 7,888) (intention-to-treat analysis). The sensitivity analyses showed a moderate influence of the cost estimates. Conclusions: PT results in clinically relevant improvement in RSD. Costs as sociated with adjuvant treatment are moderate compared to other medical cos ts. The incremental cost-effectiveness ratios of PT versus OT and CT were m oderate or even dominant, thus PT was both more effective and less costly t han its comparators.