Economic evaluation of an implementation strategy for the management of low back pain in general practice

Abstract

In connection with the publication of a clinical practice guideline on the management of low back pain (LBP) in general practice in Denmark, a cluster randomised controlled trial was conducted. In this trial, a multifaceted guideline implementation strategy to improve general practitioners' treatment of patients with LBP was compared with a usual implementation strategy. The aim was to determine whether the multifaceted strategy was cost effective, as compared with the usual implementation strategy. The economic evaluation was conducted as a cost-utility analysis where cost collected from a societal perspective and quality-adjusted life years were used as outcome measures. The analysis was conducted as a within-trial analysis with a 12-month time horizon consistent with the follow-up period of the clinical trial. To adjust for a priori selected covariates, generalised linear models with a gamma family were used to estimate incremental costs and quality-adjusted life years. Furthermore, both deterministic and probabilistic sensitivity analyses were conducted. Results showed that costs associated with primary health care were higher, whereas secondary health care costs were lower for the intervention group when compared with the control group. When adjusting for covariates, the intervention was less costly, and there was no significant difference in effect between the 2 groups. Sensitivity analyses showed that results were sensitive to uncertainty. In conclusion, the multifaceted implementation strategy was cost saving when compared with the usual strategy for implementing LBP clinical practice guidelines in general practice. Furthermore, there was no significant difference in effect, and the estimate was sensitive to uncertainty.

Effectiveness and cost-utility of a multifaceted eHealth strategy to improve back pain beliefs of patients with non-specific low back pain: a cluster randomised trial

“…This is in contrast with a very similar recent implementation study for the management of LBP. In that study, patients in the intervention group had higher LBP-related costs for primary care, but lower LBP-related costs for secondary care 46. Other studies within and outside the field of LBP however have shown similar results to the current study, where patients and participants in intervention groups show higher total medical care costs due to secondary care and/or alternative care 47–51.…”

Melatonin protects vertebral endplate chondrocytes against apoptosis and calcification via the Sirt1‐autophagy pathway

“…Low back pain (LBP) is a leading cause of disability and job‐related disability, affecting 80% of the population at some point during their life and may result in a low quality life and high healthcare costs . Intervertebral disc degeneration (IDD) has been recognized as a major contributor to LBP; however, IDD pathogenesis remains unclear.…”

BRD4 inhibition regulates MAPK, NF‐κB signals, and autophagy to suppress MMP‐13 expression in diabetic intervertebral disc degeneration

“…Intervertebral disc degeneration (IVDD) is known to contribute to low back pain (1), which is the leading cause of disability around the world (2,3). Studies from different groups including ours have shown that diabetes mellitus, especially type 2 diabetes (T2D), is a major risk factor for IVDD (4)(5)(6)(7).…”