Cost-effectiveness of providing patients with information on managing mild low-back symptoms in an occupational health setting

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Abstract

Background

Evidence shows that low back specific patient information is effective in sub-acute low back pain (LBP), but effectiveness and cost-effectiveness (CE) of information in early phase symptoms is not clear. We assessed effectiveness and CE of patient information in mild LBP in the occupational health (OH) setting in a quasi-experimental study.

Methods

A cohort of employees ( N = 312, aged <57) with non-specific, mild LBP (Visual Analogue Scale between 10–34 mm) was selected from the respondents of an employee survey ( N = 2480; response rate 71 %). A random sample, representing the natural course of LBP (NC, N = 83; no intervention), was extracted as a control group. Remaining employees were invited (181 included, 47 declined, one excluded) into a randomised controlled study with two 1:1 allocated parallel intervention arms (“Booklet”, N = 92; “Combined”, N = 89). All participants received the “Back Book” patient information booklet and the Combined also an individual verbal review of the booklet. Physical impairment (PHI), LBP, health care (HC) utilisation, and all-cause sickness absence (SA) were assessed at two years. CE of the interventions on SA days was analysed by using direct HC costs in one year, two years from baseline. Multiple imputation was used for missing values.

Results

Compared to NC, the Booklet reduced HC costs by 196€ and SA by 3.5 days per year. In 81 % of the bootstrapped cases the Booklet was both cost saving and effective on SA. Compared to NC, in the Combined arm, the figures were 107€, 0.4 days, and 54 %, respectively. PHI decreased in both interventions.

Conclusions

Booklet information alone was cost-effective in comparison to natural course of mild LBP. Combined information reduced HC costs. Both interventions reduced physical impairment. Mere booklet information is beneficial for employees who report mild LBP in the OH setting, and is also cost saving for the health care system.

Trial registration

ClinicalTrials.gov NCT00908102

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-2974-4) contains supplementary material, which is available to authorized users.

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Most cited references 36

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Measuring the global burden of low back pain.

Peter Brooks, Anthony Woolf, Lyn March … (2010)

Low back pain is a major cause of morbidity in high-, middle- and low-income countries, yet to date it has been relatively under-prioritised and under-funded. One important reason may be the low ranking it has received relative to many other conditions included in the previous Global Burden of Disease studies, due in part to a lack of uniformity in how low back pain is defined and a paucity of suitable data. We present an overview of methods we have undertaken to ensure a more accurate estimate for low back pain in the Global Burden of Disease 2005 study. This will help clinicians to contextualise the new estimates and rankings when they become available at the end of 2010. It will also be helpful in planning further population-based epidemiological studies of low back pain to ensure their estimates can be included in the future Global Burden of Disease studies. Copyright 2009 Elsevier Ltd. All rights reserved.

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Group cognitive behavioural treatment for low-back pain in primary care: a randomised controlled trial and cost-effectiveness analysis.

Sarah E Lamb, Zara Hansen, Ranjit Lall … (2010)

Low-back pain is a common and costly problem. We estimated the effectiveness of a group cognitive behavioural intervention in addition to best practice advice in people with low-back pain in primary care. In this pragmatic, multicentre, randomised controlled trial with parallel cost-effectiveness analysis undertaken in England, 701 adults with troublesome subacute or chronic low-back pain were recruited from 56 general practices and received an active management advisory consultation. Participants were randomly assigned by computer-generated block randomisation to receive an additional assessment and up to six sessions of a group cognitive behavioural intervention (n=468) or no further intervention (control; n=233). Primary outcomes were the change from baseline in Roland Morris disability questionnaire and modified Von Korff scores at 12 months. Assessment of outcomes was blinded and followed the intention-to-treat principle, including all randomised participants who provided follow-up data. This study is registered, number ISRCTN54717854. 399 (85%) participants in the cognitive behavioural intervention group and 199 (85%) participants in the control group were included in the primary analysis at 12 months. The most frequent reason for participant withdrawal was unwillingness to complete questionnaires. At 12 months, mean change from baseline in the Roland Morris questionnaire score was 1.1 points (95% CI 0.39-1.72) in the control group and 2.4 points (1.89-2.84) in the cognitive behavioural intervention group (difference between groups 1.3 points, 0.56-2.06; p=0.0008). The modified Von Korff disability score changed by 5.4% (1.99-8.90) and 13.8% (11.39-16.28), respectively (difference between groups 8.4%, 4.47-12.32; p<0.0001). The modified Von Korff pain score changed by 6.4% (3.14-9.66) and 13.4% (10.77-15.96), respectively (difference between groups 7.0%, 3.12-10.81; p<0.0001). The additional quality-adjusted life-year (QALY) gained from cognitive behavioural intervention was 0.099; the incremental cost per QALY was 1786 pound sterling, and the probability of cost-effectiveness was greater than 90% at a threshold of 3000 pound sterling per QALY. There were no serious adverse events attributable to either treatment. Over 1 year, the cognitive behavioural intervention had a sustained effect on troublesome subacute and chronic low-back pain at a low cost to the health-care provider. National Institute for Health Research Health Technology Assessment Programme. Copyright 2010 Elsevier Ltd. All rights reserved.

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A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain.

R Deyo, M Battie, D Cherkin … (1998)

There are few data on the relative effectiveness and costs of treatments for low back pain. We randomly assigned 321 adults with low back pain that persisted for seven days after a primary care visit to the McKenzie method of physical therapy, chiropractic manipulation, or a minimal intervention (provision of an educational booklet). Patients with sciatica were excluded. Physical therapy or chiropractic manipulation was provided for one month (the number of visits was determined by the practitioner but was limited to a maximum of nine); patients were followed for a total of two years. The bothersomeness of symptoms was measured on an 11-point scale, and the level of dysfunction was measured on the 24-point Roland Disability Scale. After adjustment for base-line differences, the chiropractic group had less severe symptoms than the booklet group at four weeks (P=0.02), and there was a trend toward less severe symptoms in the physical therapy group (P=0.06). However, these differences were small and not significant after transformations of the data to adjust for their non-normal distribution. Differences in the extent of dysfunction among the groups were small and approached significance only at one year, with greater dysfunction in the booklet group than in the other two groups (P=0.05). For all outcomes, there were no significant differences between the physical-therapy and chiropractic groups and no significant differences among the groups in the numbers of days of reduced activity or missed work or in recurrences of back pain. About 75 percent of the subjects in the therapy groups rated their care as very good or excellent, as compared with about 30 percent of the subjects in the booklet group (P<0.001). Over a two-year period, the mean costs of care were $437 for the physical-therapy group, $429 for the chiropractic group, and $153 for the booklet group. For patients with low back pain, the McKenzie method of physical therapy and chiropractic manipulation had similar effects and costs, and patients receiving these treatments had only marginally better outcomes than those receiving the minimal intervention of an educational booklet. Whether the limited benefits of these treatments are worth the additional costs is open to question.

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Author and article information

Contributors

J. Rantonen: +358 44 4943106 , jarmo.rantonen@fimnet.fi

Journal

Journal ID (nlm-ta): BMC Public Health

Journal ID (iso-abbrev): BMC Public Health

Title: BMC Public Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2458

Publication date (Electronic): 12 April 2016

Publication date PMC-release: 12 April 2016

Publication date Collection: 2016

Volume: 16

Electronic Location Identifier: 316

Affiliations

[ ]Finnish Institute of Occupational Health (FIOH), P.B. 40, 00251 Helsinki, Finland

[ ]Helsinki Institute for Information Technology HIIT, Department of Computer Science, Aalto University, Espoo, Finland

[ ]Department of Physical Medicine and Rehabilitation, South Karelia Social and Health Care District, Lappeenranta, Finland

[ ]Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland

[ ]National Institute for Health and Welfare, Centre for Health and Social Economics, Helsinki, Finland

[ ]Evalua International, Espoo, Finland

[ ]Hjelt Institute, Department of Public Health, University of Helsinki, Helsinki, Finland

[ ]South Karelian Institute, Lappeenranta University of Technology, Lappeenranta, Finland

[ ]University of Helsinki, Helsinki, Finland

Article

Publisher ID: 2974

DOI: 10.1186/s12889-016-2974-4

PMC ID: 4828818

PubMed ID: 27068751

SO-VID: 573120ef-3ba3-4364-b202-ab0d19832a87

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 9 December 2015

Date accepted : 21 March 2016

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100003128, Työsuojelurahasto;

Award ID: 114047

Custom metadata

ScienceOpen disciplines: Public health

Keywords: low back pain,the back book,prevention,quasi-experimental study,sickness absence,intervention,disability,cohort study,rct,health economy

Data availability:

ScienceOpen disciplines: Public health

Keywords: low back pain, the back book, prevention, quasi-experimental study, sickness absence, intervention, disability, cohort study, rct, health economy

Cost-effectiveness of providing patients with information on managing mild low-back symptoms in an occupational health setting

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China Occupational Medicine

Most cited references 36

Measuring the global burden of low back pain.

Group cognitive behavioural treatment for low-back pain in primary care: a randomised controlled trial and cost-effectiveness analysis.

A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain.

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