Cost-Effectiveness of Single Versus Multiple Sessions of Physical Therapy for Adults With Spinal Disorders: An Economic Evaluation From a Pragmatic Randomized Controlled Trial

<b>OBJECTIVE:</b> To evaluate the cost-utility of a single session compared with multiple sessions of physical therapy care for adults with spinal disorders. <b>DESIGN:</b> Economic evaluation based on a pragmatic randomized controlled trial. <b>METHODS:</b> Patients with spinal disorders who were referred for a spinal surgery consultation and triaged as nonsurgical cases by an advanced practice physical therapist were randomized to either a single session of education and exercise prescription (n = 52) or multiple sessions (6 sessions) of a multimodal physical therapy intervention (n = 54). Patients answered questionnaires on the health care resources used and related costs, as well as the EuroQol 5-dimension 5-level questionnaire at baseline and at 6, 12, and 26 weeks. Total health care costs and quality-adjusted life years (QALYs) were calculated. A cost-utility analysis comparing both groups was conducted using an intention-to-treat approach with multiple imputation to handle missing data. Nonparametric bootstrapping with 1000 resamples was performed. The incremental cost-effectiveness ratio (ICER) was subsequently calculated. Sensitivity analyses were performed. <b>RESULTS:</b> Compared to the single-session group, the multiple-session group incurred a significantly higher total health care costs of CA$368 (95% confidence interval [CI], $327 to $412) and achieved an additional 0.013 QALY (95% CI, 0.009 to 0.018). The ICER for the multiple-session approach was CA$29 787 per QALY gained compared to the single-session approach. Excluding private costs leads to similar results, while the complete-case analysis suggested that the multiple-session approach was not cost-effective. <b>CONCLUSION:</b> A multiple-session approach may be considered cost-effective compared to a single session of physical therapy for adults with spinal disorders in an advanced practice physical therapy model of care. <i>J Orthop Sports Phys Ther 2025;55(11):1-8. Epub 29 September 2025. doi:10.2519/jospt.2025.13468</i>.