Oral Presentation Sydney Spinal Symposium 2025

Cost-effectiveness of a telerehabilitation program for chronic spinal pain: a trial-based economic evaluation. (124055)

Bruno Tirotti Saragiotto 1 , Iuri Fioratti 2 , Felipe JJ Reis 3 , Vitor Vallio 4 , Junior Fandim 2 , Tie P Yamato 5 , Chris G Maher 5 , Leonardo OP Costa 2 , Gisela Miyamoto 6
  1. University of Technology Sydney, Sydney, NSW, Australia
  2. Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Sao Paulo, SP, Brazil
  3. Instituto Federal do Rio de Janeiro, Rio de Janeiro, Brazil
  4. Santa Casa de Miserocórdia de São Paulo, São Paulo, Brazil
  5. University of Sydney, Sydney, Australia
  6. Department of Health Sciences, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil

Objective: To investigate the cost-effectiveness of a telerehabilitation program for chronic spinal pain.

Background: Spinal pain is the leading cause of years lived with disability worldwide. Although the literature shows that telerehabilitation is a cost-effective intervention for chronic pain, there is no evidence on its cost-effectiveness for patients with spinal pain living in low, and middle-income countries.

Methods: Patients with chronic spinal pain, aged between 18-60 years, both sexes, and internet access were included. Patients were randomised into telerehabilitation group (n=51, internet-based self-management program) or control group (n=48, online booklet). The cost-effectiveness analysis was conducted for pain (11-point NRS) at 12-month follow-up. The cost-utility analysis was conducted for quality-adjusted life year – QALY (SF-6D, 0-1) estimated using linear interpolation between baseline, 8-weeks, six- and 12-month follow-ups. Societal costs were composed of intervention, healthcare, patient/family, and lost productivity costs.

Results: There were no differences between groups for pain and QALY. Telerehabilitation had statistically significantly lower societal costs compared to control group. The incremental cost-effectiveness ratio (ICER) showed that 1-point of improvement in pain was, on average, associated with a societal cost saving of US$810 for telerehabilitation compared to control. This represents that telerehabilitation was more effective and less costly than control. The ICER showed that one QALY gained was, on average, associated with a societal cost saving of US$1,768,523 for telerehabilitation group compared to control. The ICER was large due to the very small difference in QALY between groups (mean difference: <0.0005). The probabilities of cost-effectiveness for pain intensity were about 0.99 for societal perspective at willingness-to-pay of US$3,000/point of improvement, and for QALY were about 0.82 for the societal perspective at a willingness-to-pay of US$50,000/QALY gained.

Conclusion: The Telerehabilitation program is a cost-effective intervention for patients with chronic spinal pain, although it depends on the willingness-to-pay of the decision-maker.