Health economic assessment of behavioural rehabilitation in chronic low back pain: a randomised clinical trial

Abstract

SUMMARYThe aim of this cost-effectiveness study was to compare a combined operant programme plus cognitive/relaxation programme with an operant programme plus attention-control and to compare both programmes with a waiting-list control group and with operant rehabilitation provided, as usual, by the same rehabilitation centre. One hundred and forty eight patients with chronic low back pain were randomly assigned to the different conditions. The economic endpoints were the costs of the programme and other health care utilisation, costs for the patient, and indirect costs associated with production losses due to low back pain. The effects were measured in terms of global assessment of change and utilities, using rating scale and standard gamble methods. The 3-year study determined that adding a cognitive component to an operant treatment did not lead to significant differences in costs and improvement in quality of life when compared with the operant treatment alone. Compared with the common individual rehabilitation therapy it can be concluded that the same effects can be reached at the same or lower costs with a shorter, more intense standardised group programme. The operant treatment alone is more effective than providing no treatment in the waiting-list control group.

Lumbar spinal fusion patients’ demands to the primary health sector: evaluation of three rehabilitation protocols. A prospective randomized study

“…Hence, our findings suggest a significant effect from the incorporation of even a limited behavioral element. This comply with findings in chronic LBP patients treated conservatively [6,10,23,24]. On the other hand, a recent review of 12 RCTs by Guzman et al [8] concluded the existence of evidence for an intensive multidisciplinary rehabilitation but did not find evidence for a light multidisciplinary approach.…”

Chapter 4 European guidelines for the management of chronic nonspecific low back pain

“…One study conducted a full economic evaluation of a behavioural treatment (Goossens et al 1998). The population consisted of patients with chronic pain including chronic low back pain.…”

Cost-effectiveness of guideline-endorsed treatments for low back pain: a systematic review

“…Five of the studies did not report adequate randomization procedures [19,20,40,41], nine did not have adequate allocation concealment [18-20, 23, 24, 29, 31, 39, 41, 44, 46] and none of the studies used assessor blinding (Table 1).…”

“…Seven studies did not state the economic perspective adopted [21, 22, 29-32, 35, 41]. An incremental costeffectiveness analysis was conducted in all but 2 of the 19 cost-effectiveness or cost-utility studies [23,24,41]. Three of the nine studies which had a follow-up period of greater than 1 year did not use discounting [23][24][25]30].…”

“…In contrast, combining both manipulation and exercise with GP care was relatively cost-effective (ICER = 3,800 per QALY gained) compared to manipulation plus GP care (ICER = 4,800 per QALY gained), or exercise plus GP care (ICER = 8,300 per QALY gained) from the UK healthcare sector's perspective (in 2000-2001 GBP) [40]. One study showed that receiving an operant conditioning programme with group discussion or a cognitive behavioural component and relaxation incurred lower direct and indirect costs compared to waiting list then receiving the operant conditioning programme, but did not report an incremental cost-effectiveness analysis [41].…”