Cost-effectiveness of Pilates compared with home-based exercises for people with chronic non-specific low back pain: a trial-based economic evaluation

BACKGROUND: Evidence on the cost-effectiveness of exercise therapies for chronic low back pain is scarce in Brazil. Despite the recommendation of exercise therapies by the Brazilian Ministry of Health, some therapies, such as Pilates, are not yet covered by the Brazilian healthcare system. The aim was to investigate the cost-effectiveness of a Pilates exercise program compared with home-based exercises in individuals with chronic non-specific low back pain. DESIGN: Economic evaluation alongside a randomised controlled trial from a healthcare and societal perspective. SETTING: Rehabilitation service. PARTICIPANTS: We recruited individuals aged 18-50 years with low back pain for ≥ 12 consecutive weeks, who were randomly allocated to either Pilates (n = 72) or home-based (n = 73) exercises groups. INTERVENTIONS: Mat Pilates exercises with accessories supervised by qualified physiotherapists versus home-based exercises, twice a week, for six weeks. MAIN MEASURES: Effect outcomes included: pain intensity (Numeric Rating Scale), disability (Quebec Back Pain Disability Scale), and quality-adjusted life-years (EQ-5D-3L). Costs outcomes included total healthcare and societal costs. All outcomes were measured at baseline, post-intervention, and six-month follow-up. RESULTS: From the healthcare perspective, a 1-unit reduction in pain intensity, disability, and quality-adjusted life year gained were associated with an incremental cost of $4, $1, and $61 for Pilates compared to home-based exercises under the time horizon of six weeks of intervention with six months of follow-up, respectively. From the societal perspective, a 1-unit effect gained was associated with a cost-saving of $295, $65 and $4,293, respectively. Pilates was considered cost-effective on both perspectives, compared to home-based exercises, on the current willingness-to-pay threshold of $15,500 (R$40,000)/quality-adjusted life year gained. Sensitivity analyses were consistent with the main findings. CONCLUSION: Pilates was cost-effective compared to home-based exercises for improving pain, disability, and quality-adjusted life year of individuals with chronic non-specific low back pain from the healthcare perspective and cost-saving from the societal perspective considering the threshold set by the Brazilian public health system. TRIAL REGISTRATION: NCT03113292 (registration date 13/04/2017).