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Stratified care effective for patients at high risk for disabling low back pain
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Researchers found stratified care for low back pain did not reduce health care for patients at low risk, but reduced work absences and was a cost-effective option for patients at high risk of persistent, disabling pain.
A total of 922 patients were recruited for the study. Each patient was administered a three-level EuroQol-5D (EQ-5D), a preference-based, health-related quality-of-life instrument. The researchers adopted a cost-utility framework, using a base case analysis to estimate incremental low back pain (LBP)-related health care cost per additional quality-adjusted life year (QALY) for each risk subgroup. QALYs were determined using patients’ responses to the EQ-5D. Additionally, methodological approaches were examined using sensitivity analyses.
Compared with usual care, stratified care was the dominant treatment for patients with severe LBP, according to the researchers, which resulted in a net savings of £124 and an incremental QALY estimate of 0.023.
Patients with mid-to-severe LBP treated with stratified care reported 6 fewer days of work absence when compared with the usual care group. This resulted in a societal costs savings of about £736 and £652 per medium- and high-risk LBP patients, respectively, according to the researchers.
The researchers concluded stratified care was more cost-effective at the general practitioner level for patients at high risk of persistent, disabling LBP only. – by Robert Linnehan
Disclosure: The researchers report the IMPaCT Back study was funded by the Health Foundation (grant code: 346/4540) with support from the National Institutes for Health Research (NIHR) Primary Care Research Network-North West, the Keele Academic General Practice Partnership and the Primary Care Musculoskeletal Research Consortium.
Perspective
Back to TopJason Benecluk, PT, PhD, MPH
Risk stratified care has been described as a strategy to improve the effectiveness and efficiency of health care management for low back pain by targeting treatment to patient subgroups based on modifiable characteristics that actually influence clinical outcomes. The findings reported by Whitehurst and colleagues provide important cost-effectiveness data associated with implementing a risk-stratified care approach for low back pain in United Kingdom general practice settings. The potentially most important findings are related to high risk patients that received stratified care compared to those that received usual care are health care cost savings of £124 ($185) per patient, six fewer days of lower back pain-related work absence and societal cost savings per employed patient of £652 ($973). Collectively, these findings have potential to positively impact health care policy decision-making if similar results can be replicated within the U.S. health care system.
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