The effectiveness and cost effectiveness of self-management of di Seminar

Abstract
Aims: This randomised controlled trial evaluated the cost effectiveness of booklet-based self-management of dizziness, with or without expert telephone support.

Method: In a single blind two-centre pragmatic controlled trial, 337 patients from 35 GP practices were randomised to a) self-help booklet with telephone support from a vestibular therapist, b) self-help booklet alone, or c) routine medical care. Vertigo symptoms, anxiety, depression, dizziness handicap and quality of life were assessed by postal questionnaire at baseline, immediately post-treatment (12 weeks), and at one year follow-up.

Findings: All groups showed improvement in symptoms after 12 weeks, but by one year the routine care group had deteriorated while both treatment groups continued to improve and had significantly lower scores than the routine care group (p = .01). The two treatment groups did not differ significantly from each other at either time point. Changes in handicap scores were also significantly improved in both treatment groups relative to routine care at 12 months. Cost-effectiveness analysis concluded that both active treatments have increased benefit at increased cost that fall well within the NICE threshold for recommending treatment.

Discussion: Booklet-based self-management of dizziness, both with and without additional telephone support from a vestibular therapist, appears to have long-term benefit for dizzy patients and may be a useful tool in a stepped care approach.