A brief pain management program compared with physical therapy for low back pain: results from an economic analysis alongside a randomized clinical trial

Whitehurst, D.G.T., Lewis, M., Yao, G.L., Bryan, S., Raftery, J.P., Mullis, R. and Hay, E.M. (2007) A brief pain management program compared with physical therapy for low back pain: results from an economic analysis alongside a randomized clinical trial. Arthritis & Rheumatism, 57 (3), 466-473. (doi:10.1002/art.22606). (PMID:17394176)

Abstract

Objective: guidelines for the management of acute low back pain in primary care recommend early intervention to address psychosocial risk factors associated with long-term disability. We assessed the cost utility and cost effectiveness of a brief pain management program (BPM) targeting psychosocial factors compared with physical therapy (PT) for primary care patients with low back pain of <12 weeks' duration.

Methods: a total of 402 patients were randomly assigned to BPM or PT. We adopted a health care perspective, examining the direct health care costs of low back pain. Outcome measures were quality-adjusted life years (QALYs) and 12-month change scores on the Roland and Morris disability questionnaire. Resource use data related to back pain were collected at 12-month followup. Cost effectiveness was expressed as incremental ratios, with uncertainty assessed using cost-effectiveness planes and acceptability curves.

Results: there were no statistically significant differences in mean health care costs or outcomes between treatments. PT had marginally greater effectiveness at 12 months, albeit with greater health care costs (BPM £142, PT £195). The incremental cost-per-QALY ratio was £2,362. If the UK National Health Service were willing to pay £10,000 per additional QALY, there is only a 17% chance that BPM provides the best value for money.

Conclusion: PT is a cost-effective primary care management strategy for low back pain. However, the absence of a clinically superior treatment program raises the possibility that BPM could provide an additional primary care approach, administered in fewer sessions, allowing patient and doctor preferences to be considere

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