A Cost Utility Analysis of Interdisciplinary Early Intervention Versus Treatment as Usual for an At-Risk Population with Acute Low Back Pain

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2009-09-04

Authors

Rogerson, Mark D.

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Abstract

Chronic pain is a costly and debilitating condition that has proven difficult to treat solely with medical interventions due to the complex interplay of biological, psychological, and social factors in its onset and persistence. Many studies have demonstrated the effectiveness of interdisciplinary treatment that includes psychosocial interventions for low back pain. Nevertheless, these interventions continue to be under-utilized due to concerns of cost and applicability. The present study evaluated effectiveness and associated costs by using the objective, standard approach of a cost utility analysis. Individuals with acute low back pain that was considered at high-risk for becoming chronic (according to a previously-demonstrated algorithm) were randomized to either treatment as usual or an interdisciplinary early intervention program. Treatment effectiveness was evaluated using a standard pain measure and quality-adjusted life years (QALYs) from pre-treatment baseline to 12-month follow-up, and associated medical and employment costs were gathered every 3 months for 1 year. Results indicated that subjects improved significantly from pre-treatment to one-year follow-up, and that the early intervention group reported fewer healthcare visits and missed workdays. A cost utility analysis was conducted utilizing 1,000 bootstrapped samples, and the majority of samples indicated the dominance of the early intervention program as being both more effective and less costly from a societal perspective. Within a generally-accepted range of acceptable costs, the early intervention treatment was the preferred option in 85% to 93% of samples. Sensitivity analyses indicated that these effects were robust to changes in estimated values for associated costs. These results indicate encouraging evidence for the cost-effectiveness of interdisciplinary intervention and the benefits of targeted treatment.

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