SPINE Volume 31, Number 16, pp 1799 –1804 ©2006, Lippincott Williams & Wilkins, Inc. Active Involvement and Intervention in Patients Exposed to Whiplash Trauma in Automobile Crashes Reduces Costs A Randomized, Controlled Clinical Trial and Health Economic Evaluation Mark Rosenfeld, RPT, PhD,*† Aris Seferiadis, RPT,‡ and Ronny Gunnarsson, MD, PhD†‡ Study Design. To examine and compare the costs and consequences in a partial economic evaluation of two competing interventions in patients exposed to whiplash trauma in automobile crashes. The interventions were an active involvement and intervention using early mobiliza- tion and a standard intervention of rest, recommended short-term immobilization in a cervical collar and a cau- tious, gradual self-exercise program according to a leaf- let. The study was randomized and controlled. Objectives. The aim of the study was to compare the costs of an active involvement and intervention versus a standard intervention and to relate them to the clinical benefits in patients exposed to whiplash trauma in auto- mobile crashes to facilitate decision-making regarding in- tervention and resource allocation. Summary of Background Data. There is very little known about the health economic aspects of various in- terventions in the target treatment group of patients. Methods. Based on a prospective, randomized, clinical trial, data on clinical effectiveness and resources used for the active involvement and intervention and standard in- tervention were collected for a comparative analysis of the costs related to physical therapy treatment and sick leave. A cost-consequence analysis consisting of a mod- ified cost-effectiveness analysis was used. Results. The costs were significantly lower after 6 and 36 months with an active involvement and intervention as compared with the standard intervention. The active in- volvement and intervention were significantly superior in reducing experienced pain and reducing sick leave. Conclusions. For patients exposed to whiplash trauma in a motor vehicle collision, an active involvement and intervention were both less costly and more effective than a standard intervention. Key words: whiplash injuries, whiplash-associated dis- orders, physical therapy, cost-consequence analysis. Spine 2006;31:1799 –1804 Road traffic injuries are a major public health problem, with 5.5 million deaths and 230 million injured during the last 30 years in the western world alone. These inju- ries are extremely costly to society; and according to the World Health Organisation (WHO), traffic injuries con- stitute approximately 1% of the combined gross national products of the nations of the western world. 1 Whiplash-associated disorders (WADs) occur com- monly after road traffic accidents. The Abbreviated In- jury Scale (AIS) is an anatomic scoring system first intro- duced in 1969 and has been considered a reasonably accurate way of ranking the severity of injury. Injuries are ranked on a scale from 1 to 6 from “minor” (AIS 1) to “virtually unsurvivable injury” (AIS 6). The AIS 1 neck injuries 2 included in WADs have become the most common traffic injury with an estimated incidence of 100 per 100,000 inhabitants in Sweden. 3,4 Costs for medical care and disability and the consequences in terms of suf- fering of patients with WAD are significant, affecting patient, family, employers, and society in general, 5 al- though cost-of-illness studies for WAD present difficul- ties due to the uncertainty of the diagnosis. Deriving the division of costs is also difficult when WAD occurs along with other injuries. The costs to society for WAD in Sweden has been roughly estimated at nearly 2 billion Swedish Crowns (SEK) ($251,000,000) yearly with the bulk of these costs, 1.5 billion SEK, 2001 ($18,800,000) in lost output. 6 It is estimated that whiplash injuries cost Eu- rope €10 billion yearly ($12,100,000,000). 7 Slow and costly recovery can and should be avoided by using effective treatment methods. There is some evidence for the efficacy of an early, active involvement and inter- vention for patients with WAD, 8 –11 but no economic eval- uation has been made. Drummond defines economic eval- uation as “the comparative analysis of alternative courses of action in terms of their costs and consequences.” 12 A study in Germany similar to the Rosenfeld study but with only a 2- and 12-week follow-up concluded that considerable reduction of costs are possible if appropri- ate treatments are used in patients with WAD. 13 How- ever, no statistical analyses were presented in that study for differences in either sick-leave or costs, thus invali- dating this conclusion. The aim of the present study was to compare the costs of an active involvement and intervention versus a stan- dard intervention and relate them to the clinical effects in patients exposed to whiplash trauma in automobile crashes to facilitate decision-making regarding interven- tion and resource allocation of these patients. From the *Institute of Neuroscience and Physiology, Division of Phys- ical Therapy, Sahlgrenska Academy at Go ¨ teborg University, Go ¨ teborg, Sweden; †Research and Development Unit in Primary Health Care, Southern Elfsborg County, Sweden; and ‡Department of Primary Health Care, Go ¨ teborg University, Go ¨ teborg, Sweden. Acknowledgment date: November 3, 2005. Acceptance date: Novem- ber 22, 2005. The manuscript submitted does not contain information about medical device(s)/drug(s). Federal funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript. Address correspondence and reprint requests to Mark E. Rosenfeld, RPT, Hansalandsva ¨ gen 8, 441 63 Alingsås, Sweden; E-mail: mark@ rosenfeld.se 1799