Cost-Effectiveness of Physical Therapist Treatment in Addition to Usual Podiatry Management of Plantar Heel Pain: Economic Evaluation of a Randomized Clinical Trial

TL;DR

Adding physical therapist treatment to usual podiatry care for plantar heel pain reduces costs and improves quality of life over three years.

Contribution

Demonstrates that adding physical therapy to standard podiatry care is cost-effective for plantar heel pain.

Findings

Adding physical therapy reduced societal costs by $2708 compared to usual podiatry care.

Quality-adjusted life-years improved by 0.09 with physical therapy addition.

Cost-effectiveness probabilities exceeded 97% at a $50,000 per QALY threshold.

Abstract

Plantar heel pain (PHP) contributes to reduced quality of life and is costly to manage. Persons with PHP are infrequently referred to a physical therapist after presenting to primary care or podiatry.

The study objective was to compare the cost-effectiveness of usual podiatry care (uPOD) plus physical therapist treatment with that of uPOD alone in the management of PHP.

A cost-effectiveness analysis from societal and health care sector perspectives and a 3-year time horizon was performed alongside a randomized clinical trial. Intention to treat was used as the base case, and sensitivity analyses were used to assess the impact of adherence to treatment (ie, per protocol) and PHP-specific costs.

The setting was a multidisciplinary outpatient clinic in the United States.

Participants were 95 eligible patients with PHP.

uPOD consisted of a stretching handout, medication, injections, and orthotics; uPOD plus physical therapist treatment also included physical therapist intervention consisting of manual therapy, exercise, foot taping, and iontophoresis.

Cost-effectiveness was determined by between-group differences in costs relative to quality-adjusted life-years (QALYs). Cost-effectiveness at different thresholds of decision maker willingness to pay was illustrated using the cost-effectiveness acceptability curve.

uPOD plus physical therapist treatment reduced societal costs by $2708 (95% CI = −$294 to $5709) relative to uPOD and increased QALYs by 0.09 (95% CI = −0.01 to 0.18). The cost-effectiveness acceptability curve demonstrated 98%, 99%, and 97% probabilities of cost-effectiveness of uPOD plus physical therapist treatment in the base-case, per-protocol, and PHP-specific cost analyses using a willingness-to-pay threshold of $50,000 per QALY.

Adding physical therapist treatment to uPOD lowered total costs and improved quality of life despite increased short-term health care utilization. Results were not altered when considering adherence to treatment or PHP-specific costs.

This study informs shared decision-making between providers and patients with PHP about the costs and benefits of adding physical therapist treatment and provides support for the economic value of physical therapist treatment for PHP.

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