Cost-effectiveness of upper extremity dry needling in the rehabilitation of patients with stroke.

INTRODUCTION: Dry needling (DN) has been shown to be effective for the treatment of upper extremity hypertonia in patients with stroke. PURPOSE: To evaluate the cost-effectiveness of DN in patients with stroke. METHODS: A cost-effectiveness analysis was performed in a research study conducted at a Spanish public hospital where patients were classified into two groups with or without DN. Hypertonia was measured using the Modified Modified Ashworth Scale (MMAS), and quality of life (QOL) was assessed using the EuroQoL 5-dimension questionnaire. Data regarding the effects and costs of physiotherapy were presented by calculating the mean and 95% confidence interval. The health outcomes were evaluated considering the rate of responders to the treatment based on the MMAS. Spanish preference weights were used to estimate quality-adjusted life years (QALYs). The incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR) were calculated to determine the economic value of DN. RESULTS: Eighty patients with stroke in the subacute stage of recovery were selected to participate in this study. Based on the rate of responders, the ICER of the DN group was very low. Despite the sensitivity analysis performed, the results of the ICUR were not encouraging. DISCUSSION: Cost-effectiveness with responder rate results were favourable for the DN group and were confirmed by the sensitivity analysis according to levels of care. In addition, our findings revealed that 4 weeks of treatment could be more cost-effective than 8 weeks. DN treatment of the upper extremity appears to be cost-effective based on the rate of responders measured using the MMAS scale.

A comparative study of treatment interventions for patellar tendinopathy: a secondary cost-effectiveness analysis.

OBJECTIVE: To compare the cost-effectiveness of three patellar tendinopathy treatments. DESIGN: Secondary (cost-effectiveness) analysis of a blinded, randomised controlled trial, with follow-up at 10 and 22 weeks. SETTINGS: Recruitment was performed in sport clubs. The diagnosis and the intervention were carried out at San Jorge University. PARTICIPANTS: The participants were adults between 18 and 45 years (n = 48) with patellar tendinopathy. INTERVENTIONS: Participants received percutaneous needle electrolysis, dry needling or sham needling, all of which were combined with eccentric exercise. MAIN OUTCOME MEASURES: Costs, quality-adjusted life years and incremental cost-effectiveness ratio were calculated for each group. RESULTS: The total cost per session was similar in the three groups: €9.46 for the percutaneous needle electrolysis group; €9.44 for the dry needling group; and €8.96 for the sham group. The percutaneous needle electrolysis group presented better cost-effectiveness in terms of quality-adjusted life years and 96% and 93% probability of being cost-effective compared to the sham and dry needling groups, respectively. CONCLUSION: Our study shows that percutaneous needle electrolysis has a greater probability of being cost-effective than sham or dry needling treatment.

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

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.

[Prevalence of antiparkinsonian treatment complications: a systematic review and estimation of projections]. / Prevalencia de las complicaciones del tratamiento antiparkinsoniano: revision sistematica y estimacion de proyecciones.

INTRODUCTION: The development of Parkinson's disease (PD) presents different complications deriving from the disease itself, but also from its treatment. The appearance of side effects with the use of antiparkinsonian drugs is common and their management is complicated, which makes it necessary to determine the epidemiological impact of these problems related with antiparkinsonian medication. AIM: To estimate the prevalence of the side effects of the treatment for the motor symptoms of PD and the possible long-term impact. PATIENTS AND METHODS: A systematic review was performed in the biomedical databases since the year 2004; the most relevant studies were selected and the frequencies of the most common side effects were identified. The data thus obtained were projected in order to estimate their impact in the long term. RESULTS: Altogether 218 studies were identified, of which 24 were selected for the review. Data were obtained for 20 types of complications deriving from the antiparkinsonian treatment, including heart problems, oedemas and neuropsychiatric symptoms. CONCLUSIONS: The estimations performed indicate that the number of patients with PD and therefore the prevalence of the side effects of antiparkinsonian treatments may well double by the year 2050.

TITLE: Prevalencia de las complicaciones del tratamiento antiparkinsoniano: revision sistematica y estimacion de proyecciones.Introduccion. El desarrollo de la enfermedad de Parkinson (EP) presenta diferentes complicaciones derivadas de la propia enfermedad, pero tambien de su tratamiento. La aparicion de efectos adversos con el uso de antiparkinsonianos es comun y su manejo es complicado, por lo que se hace necesario determinar el impacto epidemiologico de estos problemas relacionados con los medicamentos antiparkinsonianos. Objetivo. Estimar la prevalencia de los efectos adversos del tratamiento de los sintomas motores de la EP y su posible impacto a largo plazo. Pacientes y metodos. Se realizo una revision sistematica en bases de datos biomedicas desde el año 2004; se seleccionaron los estudios mas relevantes y se identificaron las frecuencias de los efectos adversos mas comunes. Se proyectaron los datos obtenidos para estimar su impacto a largo plazo. Resultados. Se identificaron 218 estudios, de los cuales 24 fueron seleccionados para la revision. Se obtuvieron datos para 20 tipos de complicaciones del tratamiento antiparkinsoniano, entre las que se encuentran problemas cardiacos, edemas y sintomas neuropsiquiatricos. Conclusion. Las estimaciones realizadas indican que el numero de pacientes de EP y, consecuentemente, la prevalencia de los efectos adversos de los tratamientos antiparkinsonianos pueden duplicarse en el año 2050.