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Cost-effectiveness of physiotherapy in childhood functional constipation: a randomized controlled trial in primary
Jojanneke J G T van Summeren1, Gea A Holtman1, Yvonne Lisman-van Leeuwen1
1University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, Groningen, The Netherlands.
Insights
Adding physiotherapy to conventional treatment for childhood functional constipation is not cost-effective for all patients. However, it may be cost-effective for children with chronic laxative use.
Area of Science:
- Pediatric Gastroenterology
- Health Economics
- Evidence-Based Practice
Background:
- Functional constipation (FC) in children incurs significant healthcare costs.
- Conventional treatment (CT) for FC is successful in only 50% of cases.
- There is a need to evaluate cost-effective management strategies for pediatric FC.
Purpose of the Study:
- To determine if physiotherapy added to CT is a cost-effective strategy for managing FC in children aged 4-18 years in primary care.
- To compare the cost-effectiveness of physiotherapy plus CT versus CT alone.
Main Methods:
- A randomized controlled trial (RCT) with an 8-month follow-up was conducted.
- Cost-effectiveness analysis was performed from a societal perspective.
- Treatment success was defined as absence of FC and no laxative use (primary) or absence of FC irrespective of laxative use (secondary).
Main Results:
- The incremental cost-effectiveness ratio (ICER) for the primary outcome was €24,060 per successfully treated child.
- The ICER for the secondary outcome was €1,221 per child without FC.
- For children with chronic laxative use, the ICER was €571 for the secondary outcome, suggesting potential cost-effectiveness.
Conclusions:
- Physiotherapy as a first-line treatment added to CT for all children with FC is not cost-effective compared to CT alone.
- Further research should investigate the cost-effectiveness of adding physiotherapy to CT specifically for children with chronic laxative use.
Objective:
Health care expenditures for children with functional constipation (FC) are high, while conservative management is successful in only 50% of the children. The aim is to evaluate whether adding physiotherapy to conventional treatment (CT) is a cost-effective strategy in the management of children with FC aged 4-18 years in primary care.
Methods:
A cost-effectiveness analysis was performed alongside a randomized controlled trial (RCT) with 8-month follow-up. Costs were assessed from a societal perspective, effectiveness included both the primary outcome (treatment success defined as the absence of FC and no laxative use) and the secondary outcome (absence of FC irrespective of laxative use). Uncertainty was assessed by bootstrapping and cost-effectiveness acceptability curves (CEACs) were displayed.
Results:
One hundred and thirty-four children were randomized. The incremental cost-effectiveness ratio (ICER) for one additional successfully treated child in the physiotherapy group compared with the CT group was €24,060 (95% confidence interval [CI] €-16,275 to €31,390) and for the secondary outcome €1,221 (95% CI €-12,905 to €10,956). Subgroup analyses showed that for children with chronic laxative use the ICER was €2,134 (95% CI -24,975 to 17,192) and €571 (95% CI 11 to 3,566), respectively. At a value of €1,000, the CEAC showed a probability of 0.53 of cost-effectiveness for the primary outcome, and 0.90 for the secondary outcome.
Conclusions:
Physiotherapy added to CT as first-line treatment for all children with FC is not cost-effective compared with CT alone. Future studies should consider the cost-effectiveness of physiotherapy added to CT in children with chronic laxative use.
Trial Registration:
The RCT is registered in the Netherlands Trial Register (NTR4797), on the 8th of September 2014. The first child was enrolled on the 2nd of December 2014. https://www.trialregister.nl/trial/4654.
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