Is group-based physiotherapy a cost-effective intervention compared to usual one-on-one physiotherapy care in the management of musculoskeletal disorders in active military personnel? An economic evaluation alongside a pragmatic randomized clinical trial

Abstract: Objective: To conduct a cost-utility analysis of a group physiotherapy intervention, compared to usual care, for musculoskeletal disorders in Canadian military personnel. Design: Economic evaluation alongside a pragmatic randomized clinical trial. Methods: One hundred and twenty military members presenting with shoulder, knee, ankle, or low back pain were randomized to receive either usual one-on-one physiotherapy care or a group intervention. Cumulative health care costs were prospectively collected over 26 weeks from the perspective of the Canadian Armed Forces. The clinical outcome of the cost-utility analysis was the quality-adjusted life-year (QALY) estimated by the ED-5Q-5L (European Quality of Life 5 Dimensions 5 Level Version) at baseline, 6, 12, and 26 weeks. The incremental cost-effectiveness ratio (ICER) was estimated by the cost difference between interventions (in 2023 Canadian dollars [CAD$]) divided by the effect difference. Results: The mean QALY gain was 0.011 in the group intervention, and 0.010 in the usual care. The average cost for a patient was CAD $532 in the group intervention and CAD $599 in the usual care. The ICER (-$67 000/QALY) indicated that the group intervention was cost-effective, as it costs less than usual care while providing comparable effectiveness. Conclusion: Group interventions were cost-effective compared to usual care for treating musculoskeletal disorders in military personnel.

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