Abstract
BackgroundLow back pain (LBP), with high incidence and prevalence rate, is one of the most common reasons to consult the health system and is responsible for a significant amount of sick leave, leading to high health and social costs. The objective of the study is to assess the cost-effectiveness and cost-utility analysis of a multidisciplinary biopsychosocial educational group intervention (MBEGI) of non-specific sub-acute LBP in comparison with the usual care in the working population recruited in primary healthcare centres.Methods/designThe study design is a cost-effectiveness and cost-utility analysis of a MBEGI in comparison with the usual care of non-specific sub-acute LBP.Measures on effectiveness and costs of both interventions will be obtained from a cluster randomised controlled clinical trial carried out in 38 Catalan primary health care centres, enrolling 932 patients between 18 and 65 years old with a diagnosis of non-specific sub-acute LBP. Effectiveness measures are: pharmaceutical treatments, work sick leave (% and duration in days), Roland Morris disability, McGill pain intensity, Fear Avoidance Beliefs (FAB) and Golberg Questionnaires. Utility measures will be calculated from the SF-12. The analysis will be performed from a social perspective. The temporal horizon is at 3 months (change to chronic LBP) and 12 months (evaluate the outcomes at long term).Assessment of outcomes will be blinded and will follow the intention-to-treat principle.DiscussionWe hope to demonstrate the cost-effectiveness and cost-utility of MBEGI, see an improvement in the patients' quality of life, achieve a reduction in the duration of episodes and the chronicity of non-specific low back pain, and be able to report a decrease in the social costs. If the intervention is cost-effectiveness and cost-utility, it could be applied to Primary Health Care Centres.Trial registrationISRCTN: ISRCTN58719694
Highlights
Introduction to health economics for physiciansLancet 2001, 358:993-998.24
We hope to demonstrate the cost-effectiveness and cost-utility of multidisciplinary biopsychosocial educational group intervention (MBEGI), see an improvement in the patients’ quality of life, achieve a reduction in the duration of episodes and the chronicity of non-specific low back pain, and be able to report a decrease in the social costs
If the intervention is cost-effectiveness and cost-utility, it could be applied to Primary Health Care Centres
Summary
We hope to contribute evidence about the cost-effectiveness and cost-utility of MBEGI in reducing episodes of non-specific LBP and the associated social and health costs. Some costs have been eliminated, such as those attributable to the primary care centre operations, since we could assume that there will be no relevant differences between the treatment and control group in this regard It is worth highlighting the inclusion of the concept of presenteeism in estimating labour costs. Despite the 1-year time horizon, our study includes data from more than a natural year, so the possible effect of inflation could slightly modify the prices and values of the different variables To minimise these effects, we will convert costs and benefits obtained in different years to a base year: the year with the most recently published price levels. ■ decreased intensity of LBP ■ decreased duration of the episode and recurrent LBP ■ improved quality of life ■ decreased incidence of chronic LBP ■ decreased days of labour absenteeism and presenteeism ■ reduced pharmacy costs ■ reduced costs to the National Health System in the provision of services due to this pathology ■ Reduced social costs to the patient and his/her family
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