Is exposure in vivo cost-effective for chronic low back pain A trial-based economic evaluationReport as inadecuate

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BMC Health Services Research

, 15:549

First Online: 14 December 2015Received: 19 September 2014Accepted: 04 December 2015DOI: 10.1186-s12913-015-1212-6

Cite this article as: Goossens, M.E.J.B., de Kinderen, R.J.A., Leeuw, M. et al. BMC Health Serv Res 2015 15: 549. doi:10.1186-s12913-015-1212-6


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

KeywordsChronic low back pain exposure in vivo economic evaluation costs QALYs AbbreviationsCBTcognitive behavioral treatment

CEAcost-effectiveness analysis

CEACcost-effectiveness acceptability curve

CLBPchronic low back pain

CUAcost-utility analysis

EXPexposure in vivo

GAgraded activity

ICERincremental cost-effectiveness ratio

PHODAPhotograph Series of Daily Activities

QALYquality-adjusted life year

QBPDSQuebec Back Pain Disability Scale

SDstandard deviation

SF-36Short Form 36

SPSSStatistical Package for Social Sciences

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Author: Marielle E. J. B. Goossens - Reina J. A. de Kinderen - Maaike Leeuw - Jeroen R. de Jong - Joop Ruijgrok - Silvia M. A



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