Is exposure in vivo cost-effective for chronic low back pain? A trial-based economic evaluation

Abstract

BackgroundBack pain is one of the most expensive health complaints. Comparing the economic aspects of back pain interventions may therefore contribute to a more efficient use of available resources. This study reports on a long-term cost-effectiveness analysis (CEA) and cost-utility analysis (CUA) of two treatments as viewed from a societal perspective: 1) exposure in vivo treatment (EXP), a recently developed cognitive behavioral treatment for patients with chronic low back pain who have elevated pain-related fear and 2) the more commonly used graded activity (GA) treatment.MethodsSixty-two patients with non-specific chronic low back pain received either EXP or GA. Primary data were collected at four participating treatment centers in the Netherlands. Primary outcomes were self-reported disability (for the CEA) and quality-adjusted life years (for the CUA). Program costs, health care utilization, patient and family costs, and production losses were measured by analyzing therapy records and cost diaries. Data was gathered before, during, and after treatment, and at 6 and 12 months after treatment. Non-parametric bootstrap analyses were used to quantify the uncertainty concerning the cost-effectiveness ratio. In addition, cost-effectiveness planes and cost-effectiveness acceptability curves were performed.ResultsEXP showed a tendency to reduce disability, increase quality adjusted life years and decrease costs compared to GA. The incremental cost-effectiveness ratios of both the CEA and CUA are in favor of EXP.ConclusionsBased on these results, implementing EXP for this group of patients seems to be the best decision.Trial registrationISRCTN88087718

The Economic Utility of Clinical Psychology in the Multidisciplinary Management of Pain

“…Various RCTs evaluated the cost-effectiveness of group cognitive behavioral approaches for chronic low back pain, with estimates of additional cost per QALY ranging from £1,786 to $7,197 (Linton and Nordin, 2006 ; Lamb et al, 2010 ; Norton et al, 2015 ). An integrated care program for sick-listed back pain patients based on a workplace intervention and graded activity was found to provide work-related economic savings in the amount of £5744 (Lambeek et al, 2010 ), but graded activity was found to be less cost-effective than exposure in vivo in another trial (Goossens et al, 2015 ). Non-significant effects were found for a CBT program added to inpatient rehabilitation for chronic low back pain (Schweikert et al, 2006 ).…”

EXPOSURE IN VIVOVERSUSPAIN-CONTINGENT PHYSICAL THERAPY IN COMPLEX REGIONAL PAIN SYNDROME TYPE I: A COST-EFFECTIVENESS ANALYSIS

“…In CRPS-I, no other studies on the cost-effectiveness of rehabilitation are available. The cost-effectiveness of EXP was previously evaluated in a study comparing EXP with graded activity (GA) for individuals with low back pain (29). EXP was the preferred treatment regarding societal costs, but less convincing than in the current study, possibly because the contrast between EXP and GA, two biopsychosocial interventions, is less pronounced than between EXP and PPT, which has a biomedical focus.…”

<p>An Experimental Analogue Study on the “Dose-Response Relationship” of Different Therapeutic Instructions for Pain Exposures: The More, The Better?</p>

“…Taking into account that chronic pain is often treated in multidisciplinary (inpatient) settings with restricted schedules, rapid responses seem highly relevant. 36,64 Higher levels of pain anxiety and lower levels of pain catastrophizing in our healthy sample were predicted fewer trials needed, independently of the instruction type. Considering this finding in a broader context with regard to findings from clinical samples, this may appear contradictory at first glance: while higher pain anxiety was associated with fewer trials needed, higher pain catastrophizing was related to more trials needed.…”