Economic evaluation of advanced practice physiotherapy models of care: a systematic review with meta-analyses

BMC Health Services Research

Carlo Santaguida¹  Julio Fernandes²  Anthony Demont³  Kednapa Thavorn⁴  Simon Lafrance⁵  François Desmeules⁵ 

[1] Department of Neurology and Neurosurgery, Faculty of Medecine, McGill University Health Center, Montreal, Quebec, Canada;Hôpital du Sacré-Coeur de Montréal Research Center, Université de Montréal Affiliated Research Center, Montreal, Quebec, Canada;Department of Surgery, Faculty of Medecine, Université de Montréal, Montreal, Quebec, Canada;INSERM 1123 ECEVE, Faculty of Medicine, Paris-Diderot University, Paris, France;Physiotherapy School, University of Orleans, Orleans, France;School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada;Ottawa Hospital Research Institute, Ottawa, ON, Canada;School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada;Maisonneuve-Rosemont Hospital Research Center, Université de Montréal Affiliated Research Center, Montreal, Quebec, Canada;

关键词: Physical therapy specialty;    Physical therapists;    Health planning;    Economics;    Cost analysis;    health care costs;    Health expenditures;    “Physiotherapy”;    “Physical therapy” and “advanced practice”;   

DOI  :  10.1186/s12913-021-07221-6

来源: Springer

【 摘 要 】

BackgroundThe objective of this systematic review is to appraise evidence on the economic evaluations of advanced practice physiotherapy (APP) care compared to usual medical care.MethodsSystematic searches were conducted up to September 2021 in selected electronic bibliographical databases. Economic evaluation studies on an APP model of care were included. Economic data such as health care costs, patient costs, productivity losses were extracted. Methodological quality of included studies was assessed with the Effective Public Health Practice Project tool and the Critical Appraisal Skills Programme checklist. Meta-analyses were performed and mean differences (MD) in costs per patient were calculated using random-effect inverse variance models. Certainty of the evidence was assessed with the GRADE Approach.ResultsTwelve studies (n = 14,649 participants) including four randomized controlled trials, seven analytical cohort studies and one economic modeling study were included. The clinical settings of APP models of care included primary, emergency and specialized secondary care such as orthopaedics, paediatrics and gynaecology. The majority of the included participants were adults with musculoskeletal disorders (n = 12,915). Based on low quality evidence, health system costs including salaries, diagnostic tests, medications, and follow-up visits were significantly lower with APP care than with usual medical care, at 2 to 12-month follow-up (MD: -139.08 €/patient; 95%CI: -265.93 to -12.23; n = 7648). Based on low quality evidence, patient costs including travel and paid medication prescriptions, or treatments were significantly higher with APP care compared to usual medical care, at 2 to 6-month follow-up (MD: 29.24 €/patient; 95%CI: 0.53 to 57.95 n = 1485). Based on very low quality evidence, no significant differences in productivity losses per patient were reported between both types of care (MD: 590 €/patient; 95%CI: -100 to 1280; n = 819).ConclusionsThis is the first systematic review and meta-analysis on the economic evaluation of APP models of care. Low quality evidence suggests that APP care might result in lower health care costs, but higher patient costs compared to usual medical care. Costs differences may vary depending on various factors such as the cost methodology used and on the clinical setting. More evidence is needed to evaluate cost benefits of APP models of care.

【 授权许可】

CC BY