Protocol for an economic evaluation alongside the University Health Network Whiplash Intervention Trial: cost-effectiveness of education and activation, a rehabilitation program, and the legislated standard of care for acute whiplash injury in Ontario
1 Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, Toronto, ON Canada
2 Institute for Work & Health, Toronto, ON Canada
3 Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, Toronto, ON Canada
4 Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
5 Centre for Research on Inner City Health, Keenan Research Centre in the Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, ON Canada
6 Department of Health Policy Management and Evaluation, University of Toronto, Toronto, ON Canada
7 Department of Medicine, University of Toronto, Toronto, ON Canada
8 Department of Medicine, Mount Sinai Hospital, Toronto, ON Canada
9 Division of Rheumatology, University Health Network, Toronto, ON Canada
10 Department of Health Sciences, Faculty of Earth & Life Sciences, VU University, Amsterdam, Netherlands
BMC Public Health 2011, 11:594 doi:10.1186/1471-2458-11-594Published: 27 July 2011
Whiplash injury affects 83% of persons in a traffic collision and leads to whiplash-associated disorders (WAD). A major challenge facing health care decision makers is identifying cost-effective interventions due to lack of economic evidence. Our objective is to compare the cost-effectiveness of: 1) physician-based education and activation, 2) a rehabilitation program developed by Aviva Canada (a group of property and casualty insurance providers), and 3) the legislated standard of care in the Canadian province of Ontario: the Pre-approved Framework Guideline for Whiplash developed by the Financial Services Commission of Ontario.
The economic evaluation will use participant-level data from the University Health Network Whiplash Intervention Trial and will be conducted from the societal perspective over the trial's one-year follow-up. Resource use (costs) will include all health care goods and services, and benefits provided during the trial's 1-year follow-up. The primary health effect will be the quality-adjusted life year. We will identify the most cost-effective intervention using the incremental cost-effectiveness ratio and incremental net-benefit. Confidence ellipses and cost-effectiveness acceptability curves will represent uncertainty around these statistics, respectively. A budget impact analysis will assess the total annual impact of replacing the current legislated standard of care with each of the other interventions. An expected value of perfect information will determine the maximum research expenditure Canadian society should be willing to pay for, and inform priority setting in, research of WAD management.
Results will provide health care decision makers with much needed economic evidence on common interventions for acute whiplash management.