Remotely delivered physiotherapy for musculoskeletal conditions is cost saving for the health system and patients: economic evaluation of the REFORM randomised trial

Abstract

QUESTIONS: Is remotely delivered physiotherapy cost saving when compared with usual face-to-face physiotherapy as typically provided in a public hospital outpatient setting? Is remotely delivered physiotherapy cost-effective? DESIGN: Economic evaluation embedded within a randomised controlled, non-inferiority trial using a health system plus patient perspective. PARTICIPANTS: Patients with musculoskeletal conditions presenting to Sydney public hospitals for physiotherapy treatment. INTERVENTION: REFORM was a randomised controlled trial comparing remotely delivered physiotherapy with usual care provided in an outpatient setting. Remotely delivered physiotherapy involved one face-to-face physiotherapy session in conjunction with text messages, phone calls and an individualised exercise program delivered through an 'App'. OUTCOME MEASURES: The economic evaluation included the Patient Specific Functional Scale at 6 weeks in the cost-minimisation and cost-effectiveness analyses, and quality-adjusted life years (QALYs) at 26 weeks in the cost-utility analysis. Health system and patient resource use were derived from patient self-report. RESULTS: Costs per participant over 6 weeks were AUD $742 for remotely delivered physiotherapy and $910 for face-to-face physiotherapy, with a mean cost difference of -$168 (95% CI -$339 to $1). There was a 98% probability of remotely delivered physiotherapy being cost saving within the non-inferiority margin of the Patient Specific Functional Scale, and an 88% probability of being dominant to face-to-face physiotherapy (less costly and more effective). There was a 51% probability of being cost-effective at a nominal $50,000/QALY threshold. CONCLUSION: Moving people with musculoskeletal conditions to a remote model of physiotherapy care is potentially cost saving for health systems and patients, without compromising health outcomes when compared with currently provided public hospital care. TRIAL REGISTRATION: ACTRN12619000065190.