Neck-Specific Exercises With Internet Support Versus Standard Neck-Specific Exercise for the Treatment of Chronic Whiplash-Associated Disorders: Cost-Effectiveness Analysis.
Swarupa N Kshirsagar, Anneli Peolsson, Gunnel Peterson et al.
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In 30 seconds
This prospective, multicenter randomized controlled trial compared a 3-month internet-supported neck-specific exercise program plus four physiotherapy visits (NSEIT) with clinic-based neck-specific exercise twice weekly for 24 sessions (NSE) in 140 people with chronic moderate-to-severe whiplash-associated disorders. At 15 months, NSEIT cost SEK 12,882 versus SEK 40,087 for NSE, while health-related quality-of-life scores were 0.662 and 0.711, respectively. Thus, internet-supported exercise was less costly but also less effective on this outcome; its incremental cost-effectiveness ratio was SEK 555,209.80 per point.
Key findings
- At 15 months, total costs were SEK 12,882 for NSEIT and SEK 40,087 for NSE.
- At 15 months, health-related quality-of-life scores were 0.662 with NSEIT and 0.711 with NSE.
- The ICER for health-related quality of life was SEK 555,209.80 per point for NSEIT compared with NSE.
- At a willingness-to-pay threshold of SEK 500,000 per point, the probability NSEIT was cost-effective despite a loss of HRQoL was 0.57.
Why it matters
The comparison highlights a trade-off between lower costs and slightly poorer reported health-related quality of life when exercise is delivered with internet support rather than through repeated clinic visits. Cost-effectiveness estimates can inform evaluation of delivery models, but should be interpreted alongside patient outcomes and the costs included in the analysis.
What to keep in mind
The authors note that presenteeism costs were excluded, health care use was self-reported, and the difference in health outcomes was small, limiting confidence in the findings.