Abstract
BackgroundBack pain is one of the most expensive health complaints. Comparing the economic aspects of back pain interventions may therefore contribute to a more efficient use of available resources. This study reports on a long-term cost-effectiveness analysis (CEA) and cost-utility analysis (CUA) of two treatments as viewed from a societal perspective: 1) exposure in vivo treatment (EXP), a recently developed cognitive behavioral treatment for patients with chronic low back pain who have elevated pain-related fear and 2) the more commonly used graded activity (GA) treatment.MethodsSixty-two patients with non-specific chronic low back pain received either EXP or GA. Primary data were collected at four participating treatment centers in the Netherlands. Primary outcomes were self-reported disability (for the CEA) and quality-adjusted life years (for the CUA). Program costs, health care utilization, patient and family costs, and production losses were measured by analyzing therapy records and cost diaries. Data was gathered before, during, and after treatment, and at 6 and 12 months after treatment. Non-parametric bootstrap analyses were used to quantify the uncertainty concerning the cost-effectiveness ratio. In addition, cost-effectiveness planes and cost-effectiveness acceptability curves were performed.ResultsEXP showed a tendency to reduce disability, increase quality adjusted life years and decrease costs compared to GA. The incremental cost-effectiveness ratios of both the CEA and CUA are in favor of EXP.ConclusionsBased on these results, implementing EXP for this group of patients seems to be the best decision.Trial registrationISRCTN88087718
Highlights
Back pain is one of the most expensive health complaints
Patients and comparability After screening, 85 patients were included in the study: were randomized to Exposure in vivo (EXP) treatment and to graded activity (GA) treatment
Sixty-two patients completed enough diary entries during the months of treatment and follow-up to be included in the economic analysis: 72.1 % in the GA group (31 out of 43 patients) and 73.8 % in the EXP group (31 out of 42 patients)
Summary
Back pain is one of the most expensive health complaints. Comparing the economic aspects of back pain interventions may contribute to a more efficient use of available resources. This study reports on a long-term cost-effectiveness analysis (CEA) and cost-utility analysis (CUA) of two treatments as viewed from a societal perspective: 1) exposure in vivo treatment (EXP), a recently developed cognitive behavioral treatment for patients with chronic low back pain who have elevated pain-related fear and 2) the more commonly used graded activity (GA) treatment. Non-specific chronic low back pain (CLBP) is one of the most common health problems in Western societies, it is one of the most expensive in terms of health care costs and costs to society [1]. The economic consequences of chronic pain are felt by the patient; other parties, such as the family, social environment, health care providers, and employers, are all directly or indirectly. The most favorable treatment approach for non-specific CLBP incorporates cognitive behavioral therapy (CBT) techniques.
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