# 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.

## Key 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.