Economic evaluation of a healthy lifestyle intervention for chronic low back pain: A randomized controlled trial

Abstract

Background Economic evaluations which estimate cost‐effectiveness of potential treatments can guide decisions about real‐world healthcare services. We performed an economic evaluation of a healthy lifestyle intervention targeting weight loss, physical activity and diet for patients with chronic low back pain, who are overweight or obese. Methods Eligible patients with chronic low back pain (n = 160) were randomized to an intervention or usual care control group. The intervention included brief advice, a clinical consultation and referral to a 6‐month telephone‐based healthy lifestyle coaching service. The primary outcome was quality‐adjusted life years (QALYs). Secondary outcomes were pain intensity, disability, weight and body mass index. Costs included intervention costs, healthcare utilization costs and work absenteeism costs. An economic analysis was performed from the societal perspective. Results Mean total costs were lower in the intervention group than the control group (‐$614; 95%CI: −3133 to 255). The intervention group had significantly lower healthcare costs (‐$292; 95%CI: −872 to −33), medication costs (−$30; 95%CI: −65 to −4) and absenteeism costs (‐$1,000; 95%CI: −3573 to −210). For all outcomes, the intervention was on average less expensive and more effective than usual care, and the probability of the intervention being cost‐effective compared to usual care was relatively high (i.e., 0.81) at a willingness‐to‐pay of $0/unit of effect. However, the probability of cost‐effectiveness was not as favourable among sensitivity analyses. Conclusions The healthy lifestyle intervention seems to be cost‐effective from the societal perspective. However, variability in the sensitivity analyses indicates caution is needed when interpreting these findings. Significance This is an economic evaluation of a randomized controlled trial of a healthy lifestyle intervention for chronic low back pain. The findings suggest that a healthy lifestyle intervention may be cost‐effective relative to usual care.

Association of STarT Back Tool and the short form of the Örebro Musculoskeletal Pain Screening Questionnaire with multidimensional risk factors

“…This may lead to a better LBP outcome and better comprehensive welfare. Indeed, lifestyle intervention, compared to usual care, was shown as cost-effective in a randomized controlled study 40 .…”

Healthy Lifestyle Program (HeLP) for low back pain: protocol for a randomised controlled trial

“…Despite evidence suggesting the potential benefit of interventions targeting these lifestyle factors,21 22 there is only one randomised controlled trial evaluating a lifestyle intervention for patients with chronic low back pain 27 28. This study found no effect, likely due to poor adherence to the treatment.…”

“…Development of the research question and the intervention design was based on previously conducted randomised controlled trials and data from patients on the orthopaedic surgical waitlist at the John Hunter Hospital, Newcastle, Australia, in 2014 28 62. Patients were involved in pilot stages of the study to provide feedback on physiotherapy care, health coaching and resources.…”

Lifestyle Medicine for Chronic Lower Back Pain: An Evidence-Based Approach

“…Why should clinicians use lifestyle medicine interventions for managing chronic lower back pain? A randomized controlled trial 62 in the European Journal • Pain neuroscience education 57,58 Novel interventions…”

“…Why should clinicians use lifestyle medicine interventions for managing chronic lower back pain? A randomized controlled trial 62 in the European Journal of Pain showed that healthy lifestyle interventions might be cost-effective and reduce medication and absenteeism costs. Furthermore, there is a movement to address lifestyle factors and empower patients with self-care strategies to manage pain and disease.…”