Cost-Effectiveness of Upper Extremity Dry Needling in Chronic Stroke.

Daniel Fernández-Sanchis,Marina Gil-Calvo,Natalia Brandín-De La Cruz,Pablo Herrero,Carolina Jiménez-Sánchez,Sandra Calvo

doi:10.3390/healthcare10010160

Daniel Fernández-Sanchis, Marina Gil-Calvo + Show 4 more

Open Access

https://doi.org/10.3390/healthcare10010160

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Abstract

Introduction: Dry needling is a non-pharmacological approach that has proven to be effective in different neurological conditions. Objective: The aim of this study was to evaluate the cost-effectiveness of a single dry needling session in patients with chronic stroke. Methods: A cost-effectiveness analysis was performed based on a randomized controlled clinical trial. The results obtained from the values of the EuroQol-5D questionnaire and the Modified Modified Ashworth Scale were processed in order to obtain the percentage of treatment responders and the quality-adjusted life years (QALYs) for each alternative. The cost analysis was that of the hospital, clinic, or health center, including the equipment and physiotherapist. The cost per respondent and the incremental cost-effectiveness ratio of each alternative were assessed. Results: Twenty-three patients with stroke were selected. The cost of DN treatment was EUR 14.96, and the data analysis showed a favorable cost-effectiveness ratio of both EUR/QALY and EUR/responder for IG, although the sensitivity analysis using limit values did not confirm the dominance (higher effectiveness with less cost) of the dry needling over the sham dry needling. Conclusions: Dry needling is an affordable alternative with good results in the cost-effectiveness analysis—both immediately, and after two weeks of treatment—compared to sham dry needling in persons with chronic stroke.

Highlights

Dry needling is a non-pharmacological approach that has proven to be effective in different neurological conditions
The dry needling (DN) materials used for one session cost EUR 0.64, and the mean physiotherapy cost per session according to published bulletins is EUR 14.32 ± 4.39
This study explored the relationships between costs, quality of life (QOL), and hypertonia when DN is applied to the upper extremity muscles of persons with chronic stroke, with the aim of analyzing the cost-effectiveness of a single DN session via a cost–utility analysis

Summary

Introduction

Dry needling is a non-pharmacological approach that has proven to be effective in different neurological conditions. Stroke imposes a high burden in terms of direct and indirect costs: on the one hand, indirect costs because of lost productivity due to patients’ long-term disability, restricted social functioning, and premature death, leading to a detriment to the patients’ quality of life; on the other hand, direct costs of care resulting from costs of health professionals, hospital services, medications, etc. The reasons for the increase in non-pharmacological treatments such as DN are not clear, the following factors could be relevant: (1) from the patient s perspective, the adverse effects of pharmacological treatments, or a shift to more patientcentered treatments, where patients are more involved in decision making on different treatment alternatives; and (2) from the professional and health system perspective, the high costs of pharmacological treatments such as BTX-A infiltration

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