Implementing Stratified Primary Care Management for Low Back Pain: Cost-Utility Analysis Alongside a Prospective, Population-Based, Sequential Comparison Study

Whitehurst, David G. T.; Bryan, Stirling; Lewis, Martyn; Hay, Elaine M.; Mullis, Ricky; Foster, Nadine E.

Abstract

Study Design.
Within-study cost-utility analysis.

Objective.
To explore the cost-utility of implementing stratified care for low back pain (LBP) in general practice, compared with usual care, within risk-defined patient subgroups (that is, patients at low, medium, and high risk of persistent disabling pain).

Summary of Background Data.
Individual-level data collected alongside a prospective, sequential comparison of separate patient cohorts with 6-month follow-up.

Methods.
Adopting a cost-utility framework, the base case analysis estimated the incremental LBP-related health care cost per additional quality-adjusted life year (QALY) by risk subgroup. QALYs were constructed from responses to the 3-level EQ-5D, a preference-based health-related quality of life instrument. Uncertainty was explored with cost-utility planes and acceptability curves. Sensitivity analyses examined alternative methodological approaches, including a complete case analysis, the incorporation of non–back pain-related health care use and estimation of societal costs relating to work absence.

Results.
Stratified care was a dominant treatment strategy compared with usual care for patients at high risk, with mean health care cost savings of £124 and an incremental QALY estimate of 0.023. The likelihood that stratified care provides a cost-effective use of resources for patients at low and medium risk is no greater than 60% irrespective of a decision makers' willingness-to-pay for additional QALYs. Patients at medium and high risk of persistent disability in paid employment at 6-month follow-up reported, on average, 6 fewer days of LBP-related work absence in the stratified care cohort compared with usual care (associated societal cost savings per employed patient of £736 and £652, respectively).

Conclusion.
At the observed level of adherence to screening tool recommendations for matched treatments, stratified care for LBP is cost-effective for patients at high risk of persistent disabling LBP only.

Citation

Whitehurst, D. G. T., Bryan, S., Lewis, M., Hay, E. M., Mullis, R., & Foster, N. E. (2015). Implementing Stratified Primary Care Management for Low Back Pain: Cost-Utility Analysis Alongside a Prospective, Population-Based, Sequential Comparison Study. Spine, 40(6), 405-414. https://doi.org/10.1097/brs.0000000000000770

• Journal Article Type: Article
• Acceptance Date: Dec 30, 2014
• Publication Date: 2015-03
• Deposit Date: Nov 23, 2023
• Journal: Spine
• Print ISSN: 0362-2436
• Publisher: Lippincott, Williams & Wilkins
• Peer Reviewed: Peer Reviewed
• Volume: 40
• Issue: 6
• Pages: 405-414
• DOI: https://doi.org/10.1097/brs.0000000000000770
• Keywords: Neurology (clinical); Orthopedics and Sports Medicine
• Publisher URL: https://journals.lww.com/spinejournal/fulltext/2015/03150/implementing_stratified_primary_care_management.14.aspx