Cost-effectiveness of physiotherapy in childhood functional constipation: a randomized controlled trial in primary care

Objective: Health care expenditures for children with functional constipation (FC) are high, while conservative management is successful in only 50% of the children. The aim is to evaluate whether adding physiotherapy to conventional treatment (CT) is a cost-effective strategy in the management of children with FC aged 4-18 years in primary care.

Methods: A cost-effectiveness analysis was performed alongside a randomized controlled trial (RCT) with 8-month follow-up. Costs were assessed from a societal perspective, effectiveness included both the primary outcome (treatment success defined as the absence of FC and no laxative use) and the secondary outcome (absence of FC irrespective of laxative use). Uncertainty was assessed by bootstrapping and cost-effectiveness acceptability curves (CEACs) were displayed.

Results: One hundred and thirty-four children were randomized. The incremental cost-effectiveness ratio (ICER) for one additional successfully treated child in the physiotherapy group compared with the CT group was euro24,060 (95% confidence interval [CI] euro-16,275 to euro31,390) and for the secondary outcome euro1,221 (95% CI euro-12,905 to euro10,956). Subgroup analyses showed that for children with chronic laxative use the ICER was euro2,134 (95% CI -24,975 to 17,192) and euro571 (95% CI 11 to 3,566), respectively. At a value of euro1,000, the CEAC showed a probability of 0.53 of cost-effectiveness for the primary outcome, and 0.90 for the secondary outcome.

Conclusions: Physiotherapy added to CT as first-line treatment for all children with FC is not cost-effective compared with CT alone. Future studies should consider the cost-effectiveness of physiotherapy added to CT in children with chronic laxative use.