Pediatric Rheumatology Online Journal → June 2003 → Rehabilitation→ Abstract #74

A RANDOMISED CONTROLLED TRIAL INVESTIGATING THE COST EFFECTIVENESS OF HYDROTHERAPY IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS

H. A. Epps,¹ L. Ginnelly,² P. Woo,³ T. Southwood,⁴ M. Utley,⁵ S. Gallivan,⁵ M. Hurley,⁶ M. Sculpher.²

Physiotherapy, University College London Hospitals, London, United Kingdom; ²Centre for Health Economics, York University, York, United Kingdom; ³Rheumatology, Great Ormond Street Childrens Hospital, London, United Kingdom; ⁴Rheumatology, Birmingham Childrens Hospital, Birmingham, United Kingdom; ⁵Clinical Operational Research Unit, University College London, London, United Kingdom; ⁶Rehabilitation and Research, Kings College London, London, United Kingdom

Purpose: To investigate the cost-effectiveness of hydrotherapy in Juvenile Idiopathic Arthritis (JIA). Methods: Resource use & parental productivity costs at 2 & 6 months following intervention were collected from 74 patients with JIA entered into a randomised controlled trial comparing the effects of land exercise to a combination of hydrotherapy & land exercise. Patients attended hourly sessions twice a day for 2 weeks & were then treated once a week or fortnight for 2 months. Preference based health-related quality of life (HRQOL) was measured using the EQ5D which facilitated estimates of quality-adjusted life-years gained (QALYs). Analyses: A cost-utility analysis was conducted. Costs were estimated from a societal perspective, costs & QALYs gained were calculated over 6 months. Results: Hydrotherapy patients spent less time in hospital (0.48 versus 0.80 mean in-patient days), with fewer out-patient referrals, investigations, interventions & GP visits. Mean parental time from work was higher in the land than hydrotherapy group (9.57 versus 6.17 days). Drug use was higher in hydrotherapy patients. Hydrotherapy patients had higher mean costs (£20.90), primarily reflecting the cost of running a hydrotherapy pool, & modestly lower mean QALYs (-0.0478). Allowing for the uncertainty in these mean estimates, the probability of hydrotherapy & land exercise being cost-effective is less than 10% assuming a willingness to pay of up to £30,000 per QALY gained. Conclusion: This study demonstrates that there is potential for efficiency gains from hydrotherapy in health services resource use, parental productivity & school attendance. However, a combination of hydrotherapy & land exercise does not produce any additional benefits in HRQOL compared to land exercise alone & total costs are higher for hydrotherapy patients.