Economic evaluation of advanced practice physiotherapy models of care: a systematic review with meta-analyses

Abstract Background The objective of this systematic review is to appraise evidence on the economic evaluations of advanced practice physiotherapy (APP) care compared to usual medical care. Methods Systematic searches were conducted up to September 2021 in selected electronic bibliographical databas...

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Autores principales:	Simon Lafrance, Anthony Demont, Kednapa Thavorn, Julio Fernandes, Carlo Santaguida, François Desmeules
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Physical therapy specialty Physical therapists Health planning Economics Cost analysis; health care costs Health expenditures Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/d481b8f031764d29a9a3266fe618d2d7
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spelling	oai:doaj.org-article:d481b8f031764d29a9a3266fe618d2d72021-11-14T12:09:56ZEconomic evaluation of advanced practice physiotherapy models of care: a systematic review with meta-analyses10.1186/s12913-021-07221-61472-6963https://doaj.org/article/d481b8f031764d29a9a3266fe618d2d72021-11-01T00:00:00Zhttps://doi.org/10.1186/s12913-021-07221-6https://doaj.org/toc/1472-6963Abstract Background The objective of this systematic review is to appraise evidence on the economic evaluations of advanced practice physiotherapy (APP) care compared to usual medical care. Methods Systematic searches were conducted up to September 2021 in selected electronic bibliographical databases. Economic evaluation studies on an APP model of care were included. Economic data such as health care costs, patient costs, productivity losses were extracted. Methodological quality of included studies was assessed with the Effective Public Health Practice Project tool and the Critical Appraisal Skills Programme checklist. Meta-analyses were performed and mean differences (MD) in costs per patient were calculated using random-effect inverse variance models. Certainty of the evidence was assessed with the GRADE Approach. Results Twelve studies (n = 14,649 participants) including four randomized controlled trials, seven analytical cohort studies and one economic modeling study were included. The clinical settings of APP models of care included primary, emergency and specialized secondary care such as orthopaedics, paediatrics and gynaecology. The majority of the included participants were adults with musculoskeletal disorders (n = 12,915). Based on low quality evidence, health system costs including salaries, diagnostic tests, medications, and follow-up visits were significantly lower with APP care than with usual medical care, at 2 to 12-month follow-up (MD: − 145.02 €/patient; 95%CI: − 251.89 to − 38.14; n = 7648). Based on low quality evidence, patient costs including travel and paid medication prescriptions, or treatments were significantly higher with APP care compared to usual medical care, at 2 to 6-month follow-up (MD: 22.18 €/patient; 95%CI: 0.40 to 43.96; n = 1485). Based on very low quality evidence, no significant differences in productivity losses per patient were reported between both types of care (MD: 450 €/patient; 95%CI: − 80 to 970; n = 819). Conclusions This is the first systematic review and meta-analysis on the economic evaluation of APP models of care. Low quality evidence suggests that APP care might result in lower health care costs, but higher patient costs compared to usual medical care. Costs differences may vary depending on various factors such as the cost methodology used and on the clinical setting. More evidence is needed to evaluate cost benefits of APP models of care.Simon LafranceAnthony DemontKednapa ThavornJulio FernandesCarlo SantaguidaFrançois DesmeulesBMCarticlePhysical therapy specialtyPhysical therapistsHealth planningEconomicsCost analysis; health care costsHealth expendituresPublic aspects of medicineRA1-1270ENBMC Health Services Research, Vol 21, Iss 1, Pp 1-15 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Physical therapy specialty Physical therapists Health planning Economics Cost analysis; health care costs Health expenditures Public aspects of medicine RA1-1270
spellingShingle	Physical therapy specialty Physical therapists Health planning Economics Cost analysis; health care costs Health expenditures Public aspects of medicine RA1-1270 Simon Lafrance Anthony Demont Kednapa Thavorn Julio Fernandes Carlo Santaguida François Desmeules Economic evaluation of advanced practice physiotherapy models of care: a systematic review with meta-analyses
description	Abstract Background The objective of this systematic review is to appraise evidence on the economic evaluations of advanced practice physiotherapy (APP) care compared to usual medical care. Methods Systematic searches were conducted up to September 2021 in selected electronic bibliographical databases. Economic evaluation studies on an APP model of care were included. Economic data such as health care costs, patient costs, productivity losses were extracted. Methodological quality of included studies was assessed with the Effective Public Health Practice Project tool and the Critical Appraisal Skills Programme checklist. Meta-analyses were performed and mean differences (MD) in costs per patient were calculated using random-effect inverse variance models. Certainty of the evidence was assessed with the GRADE Approach. Results Twelve studies (n = 14,649 participants) including four randomized controlled trials, seven analytical cohort studies and one economic modeling study were included. The clinical settings of APP models of care included primary, emergency and specialized secondary care such as orthopaedics, paediatrics and gynaecology. The majority of the included participants were adults with musculoskeletal disorders (n = 12,915). Based on low quality evidence, health system costs including salaries, diagnostic tests, medications, and follow-up visits were significantly lower with APP care than with usual medical care, at 2 to 12-month follow-up (MD: − 145.02 €/patient; 95%CI: − 251.89 to − 38.14; n = 7648). Based on low quality evidence, patient costs including travel and paid medication prescriptions, or treatments were significantly higher with APP care compared to usual medical care, at 2 to 6-month follow-up (MD: 22.18 €/patient; 95%CI: 0.40 to 43.96; n = 1485). Based on very low quality evidence, no significant differences in productivity losses per patient were reported between both types of care (MD: 450 €/patient; 95%CI: − 80 to 970; n = 819). Conclusions This is the first systematic review and meta-analysis on the economic evaluation of APP models of care. Low quality evidence suggests that APP care might result in lower health care costs, but higher patient costs compared to usual medical care. Costs differences may vary depending on various factors such as the cost methodology used and on the clinical setting. More evidence is needed to evaluate cost benefits of APP models of care.
format	article
author	Simon Lafrance Anthony Demont Kednapa Thavorn Julio Fernandes Carlo Santaguida François Desmeules
author_facet	Simon Lafrance Anthony Demont Kednapa Thavorn Julio Fernandes Carlo Santaguida François Desmeules
author_sort	Simon Lafrance
title	Economic evaluation of advanced practice physiotherapy models of care: a systematic review with meta-analyses
title_short	Economic evaluation of advanced practice physiotherapy models of care: a systematic review with meta-analyses
title_full	Economic evaluation of advanced practice physiotherapy models of care: a systematic review with meta-analyses
title_fullStr	Economic evaluation of advanced practice physiotherapy models of care: a systematic review with meta-analyses
title_full_unstemmed	Economic evaluation of advanced practice physiotherapy models of care: a systematic review with meta-analyses
title_sort	economic evaluation of advanced practice physiotherapy models of care: a systematic review with meta-analyses
publisher	BMC
publishDate	2021
url	https://doaj.org/article/d481b8f031764d29a9a3266fe618d2d7
work_keys_str_mv	AT simonlafrance economicevaluationofadvancedpracticephysiotherapymodelsofcareasystematicreviewwithmetaanalyses AT anthonydemont economicevaluationofadvancedpracticephysiotherapymodelsofcareasystematicreviewwithmetaanalyses AT kednapathavorn economicevaluationofadvancedpracticephysiotherapymodelsofcareasystematicreviewwithmetaanalyses AT juliofernandes economicevaluationofadvancedpracticephysiotherapymodelsofcareasystematicreviewwithmetaanalyses AT carlosantaguida economicevaluationofadvancedpracticephysiotherapymodelsofcareasystematicreviewwithmetaanalyses AT francoisdesmeules economicevaluationofadvancedpracticephysiotherapymodelsofcareasystematicreviewwithmetaanalyses
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Economic evaluation of advanced practice physiotherapy models of care: a systematic review with meta-analyses

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