A Cost-efficiency Analysis of Primary Assessors for Patients With Knee Pain in Primary Care

NCT03822533 | Completed Results

• 1 other identifier: 115841healthecon
• Study Type: interventional
• Target: 363
• Locations: 1 country
• Sites: 9

Brief Summary

Background: Almost half of the Swedish population are overweight or obese. This will probably affect the incidence of osteoarthritis since overweight is a strong risk factor. Osteoarthritis consultations is expected to increase with 30-50% within the next 20 years. Today, in Swedish primary care, both physicians and physiotherapists are primary assessors for patients with suspected knee osteoarthritis. A task shifting with physiotherapists as the only primary assessor could increase the access rate to physicians in primary care for patients with more severe disorders. Yet, it is unclear what effects these different healthcare processes have and the costs of it. Purpose: The overall purpose of this study is to perform an economic evaluation of two healthcare processes, where a healthcare process initiated by a physiotherapist is compared with when it is initiated with a physician for patients with suspected knee osteoarthritis. Methods: 100 patients will be randomized either to a physiotherapists or to a physician for first assessment, diagnosis and treatment. Measurements of health-related quality of life and costs for visits to physiotherapists, physician or other healthcare provider, drug prescriptions and sick-leave will be collected. A cost-effectiveness analysis will be conducted, presenting incremental cost-effectiveness ratio (ICER) and a non-parametric bootstrapping will be conducted to demonstrate the uncertainties surrounding the ICER. Expected results: It is expected that this randomized controlled study will show the effects on quality adjusted life years, cost-efficiency and cost-utility of two different primary assessors for patients with suspected knee osteoarthritis consulting primary care. The results could clarify which profession that is most appropriate to be the primary assessor for patients with suspected knee osteoarthritis in primary care.

Conditions

Osteoarthritis, Knee

Keywords

Primary assessor; cost efficiency; physiotherapist; quality of life

Outcome Measures

Primary Outcomes (5)

• Mean Difference in Quality Adjusted Life Years (QALY)

  Health-related quality of life was used as the generic measure for health improvement and was measured at baseline, 3-, 6- and 12-month follow-up. The Swedish version of Euroqol-5 dimensions-3 levels (EQ5D-3L) was used to assess perceived self-rated health-related quality of life. The questionnaire contained five dimensions and resulted in an index ranging from -0,549 to 1 using the United Kingdom tariffs. An index of 1 indicate full health. For each participant, EQ-5D-3L index was used when calculating quality adjusted life years (QALY) using linear interpolation between each measurement point and the trapezoidal rule to calculate the "area under the curve". QALY range from 0 to 1, where 0 means death and 1 equals full health.

  12 months

• Mean Difference in Total Costs (Societal Perspective)

  Total costs with the societal perspective includes health care visits, prescribed drugs, productivity loss and unpaid work compensation. Data were retrieved from medical records.

  12 months

• Mean Difference in Total Costs (Health Care Perspective)

  Health care perspective includes health care visits and prescribed drugs. Data were collected through medical records.

  12 months

• Incremental Cost-effectiveness Ratio (ICER) - Societal Perspective

  Mean difference in costs divided by mean difference in quality adjusted life years (QALYs). Presenting the results of the cost-effectiveness analysis (ICER). Societal perspective includes health care visits, prescribed drugs, productivity loss and unpaid work compensation Incremental Cost-effectiveness Ratio was derived from the model where a measure of dispersion was not an output of the model

  12 months

• Incremental Cost-effectiveness Ratio (ICER) - Health Care Perspective

  Mean difference in costs divided by mean difference in quality adjusted life years (QALYs). Presenting the results of the cost-effectiveness analysis (ICER). Health care perspective includes health care visits and prescribed drugs. Incremental Cost-effectiveness Ratio was derived from the model where a measure of dispersion was not an output of the model

  12 months

Secondary Outcomes (7)

• Costs for Physiotherapy Visits

  12 months

• Costs for Physician Visits

  12 months

• Costs for Referrals to Radiography

  12 months

• Costs for Referrals to Orthopedic Surgeon

  12 months

• Costs for Collected Prescribed Drugs

  12 months

Study Arms (2)

Physiotherapist as primary assessor

OTHER

The healthcare process will be started with a physiotherapist assessment and treatment. Treatments could involve individual or group treatment including patient education and physical exercise. Patients can seek a physician anytime after the first assessment with the physiotherapist.

Other: Physiotherapist as primary assessor

Physician as primary assessor

OTHER

The healthcare process will be started with a physician assessment and treatment. Treatments could involve drug prescription, referral to x-ray, referral to other healthcare providers and sick-leave. Patients can seek a physiotherapist anytime after the first assessment with the physician.

Other: Physician as primary assessor

Interventions

Physiotherapist as primary assessor OTHER

Physiotherapist diagnose and treat the patient.

Physiotherapist as primary assessor

Physician as primary assessor OTHER

Physician diagnose and treat the patient.

Physician as primary assessor

Eligibility Criteria

• Age: 38 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Knee pain most of the days the last month
• Over 38 years old
• Crepitus on active motion
• Morning stiffness less than 30 minutes

You may not qualify if:

• Not been diagnosed for current knee pain
• Non-traumatic cause due to current knee pain
• No other rheumatic, severe somatic or psychological diseases that can affect the outcome measures.
• Not pregnant
• Does not know enough Swedish to answer questionnaires.

Sponsors & Collaborators

• Vastra Gotaland Region: lead

Study Sites (9)

Närhälsan Vänersborg Rehabmottagning

Vänersborg, VastraGotaland, Sweden

Location

Medpro Clinic Brålanda-Torpa Vårdcentral

Brålanda, Västra Götaland County, Sweden

Location

Medpro Clinic Lilla Edet Vårdcentral

Lilla Edet, Västra Götaland County, Sweden

Location

Närhälsan Lilla Edets Rehabmottagning

Lilla Edet, Västra Götaland County, Sweden

Location

Capio Läkarhus Hjortmossen

Trollhättan, Västra Götaland County, Sweden

Location

Närhälsan Trollhättan Rehabmottagning

Trollhättan, Västra Götaland County, Sweden

Location

Primapraktiken

Trollhättan, Västra Götaland County, Sweden

Location

Medpro Clinic Torpa Vårdcentral

Vänersborg, Västra Götaland County, Sweden

Location

Vårdcentralen Nordstan

Vänersborg, Västra Götaland County, Sweden

Location

Related Publications (4)

• Turkiewicz A, Petersson IF, Bjork J, Hawker G, Dahlberg LE, Lohmander LS, Englund M. Current and future impact of osteoarthritis on health care: a population-based study with projections to year 2032. Osteoarthritis Cartilage. 2014 Nov;22(11):1826-32. doi: 10.1016/j.joca.2014.07.015. Epub 2014 Jul 30.

  PMID: 25084132 BACKGROUND

• Walters SJ, Brazier JE. Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D. Qual Life Res. 2005 Aug;14(6):1523-32. doi: 10.1007/s11136-004-7713-0.

  PMID: 16110932 BACKGROUND

• Brazier JE, Harper R, Munro J, Walters SJ, Snaith ML. Generic and condition-specific outcome measures for people with osteoarthritis of the knee. Rheumatology (Oxford). 1999 Sep;38(9):870-7. doi: 10.1093/rheumatology/38.9.870.

  PMID: 10515649 BACKGROUND

• Ho-Henriksson CM, Svensson M, Thorstensson CA, Nordeman L. Physiotherapist or physician as primary assessor for patients with suspected knee osteoarthritis in primary care - a cost-effectiveness analysis of a pragmatic trial. BMC Musculoskelet Disord. 2022 Mar 17;23(1):260. doi: 10.1186/s12891-022-05201-3.

  PMID: 35300671 DERIVED

MeSH Terms

Conditions

Osteoarthritis, Knee

Interventions

Physical Therapists; Physicians

Condition Hierarchy (Ancestors)

Osteoarthritis; Arthritis; Joint Diseases; Musculoskeletal Diseases; Rheumatic Diseases

Intervention Hierarchy (Ancestors)

Health Personnel; Health Care Facilities Workforce and Services

Limitations and Caveats

Major organizational changes in Vastra Gotaland Region, where the study was conducted, affected the recruiting process. The research project was probably de-prioritized since the patient flow declined drastically. Hence the target number of participants needed to achieve target power was not reached due to early termination of the recruiting process.

Results Point of Contact

• Title: Chan-Mei Ho-Henriksson, PhD-student, RPT
• Organization: Region Västra Götaland, Närhälsan

chan-mei.ho@vgregion.se

+46709892821

Study Officials

• Lena Nordeman, PhD

  Närhälsan Research and development center Södra Älvsborg

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER GOV
• Responsible Party: SPONSOR

Model Details: Participants with suspected knee osteoarthritis are either randomised to a physiotherapist or a physician as primary assessor for assessment and treatment. After the first assessment that the patients are assigned to, the patients can choose to seek the other health care provider if they want to. This study focuses on analysing cost efficiency of the health care processes for patients with suspected knee osteoarthritis in primary care.

Study Record Dates

• First Submitted: January 28, 2019
• First Posted: January 30, 2019
• Study Start: February 7, 2019
• Primary Completion: March 17, 2021
• Study Completion: March 17, 2022
• Last Updated: May 6, 2024
• Results First Posted: May 6, 2024

Record last verified: 2022-04

Data Sharing

• IPD Sharing: Will not share

Locations

SE (9)