Skip to main content

Table 4 Summary of findings from meta-analyses and GRADE analyses of the evidence on health care costs, patient costs and productivity losses

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

Economic perspective

Clinical setting

Main results (95%CI)

APP care compared to UMC

No. of participants (RCTs & Obs)

Quality of included studies based on EPHPP

(no. of studies)

Certainty (GRADE)

Conclusions

Health care costs

Primary, emergency, orthopaedic & paediatric care

Costs per patient were 139.08 € lower (12.23 to 265.93) with APP care

7648

(4 RCTs & 2 Obs)

Strong: 1

Moderate: 4

Weak: 1

Low

(1, 2, 4, 5)

Evidence suggests that health care costs per patient are lower with APP care than UMC. Costs difference is large but uncertain, as cost is higher with APP care in emergency care.

Patient costs

Emergency & orthopaedic care

Costs per patient were 29.24 € higher (0.53 to 57.95) with APP care

1485

(3 RCTs)

Moderate: 3

Low

(2, 3)

Evidence suggests that patient costs per patient are significantly higher with APP care compared to UMC. Costs difference is small.

Productivity losses

Emergency & orthopaedic care

Costs per patient were 590 € higher (− 100 to 1280) with APP care

819

(2 RCTs)

Strong: 1

Moderate: 1

Very low

(2, 3, 4)

Evidence is very uncertain

Secondary analysis

APP care compared to nurse practitioners care

    

Health care costs

Primary & emergency care

Costs per patient were 136.88 € lower (90.16 to 183.6) with APP care

2613

(1 RCT & 1 Obs)

Moderate: 2

Low

(1, 2, 4, 5)

Evidence suggests that health care costs per patient is lower with APP care than nurse practitioners care

  1. Results in bold are statistically significant
  2. 1. Initially rated as moderate (some information from observational studies)
  3. 2. Downgraded due to risk of bias (most information is from studies at moderate risk of bias)
  4. 3. Downgraded due to imprecision of the results
  5. 4. Downgraded due to inconsistency of the results
  6. 5. Upgraded due to large effect of the results
  7. Health care costs measured in included studies: salaries, diagnostic tests, medication prescriptions and follow-up care with a 2 to 12 months time horizon
  8. Patient costs included: travel costs, waiting time, prescription costs, private meals, and private treatment with a 2 to 6 months time horizon
  9. Productivity losses included: work losses and work compensation with a 6 to 12 months time horizon
  10. GRADE Working Group grades of evidence:
  11. High quality: We are very confident that the true effect lies close to that of the estimate of the effect
  12. Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
  13. Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
  14. Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
  15. euro, APP Advanced practice physiotherapy, CI Confidence interval, EPHPP Effective Public Health Practice Project, Obs Observational studies, RCT Randomized controlled trial, UMC Usual medical care