Is an enhanced behaviour change intervention cost-effective compared with physiotherapy for patients with chronic low back pain? Results from a multicentre trial in Israel

Alastair Canaway, Tamar Pincus, Martin Underwood, Yair Shapiro, Gabriel Chodick, Noa Ben-Ami, Alastair Canaway, Tamar Pincus, Martin Underwood, Yair Shapiro, Gabriel Chodick, Noa Ben-Ami

Abstract

Objective: To assess the cost-effectiveness of an enhanced transtheoretical model of behaviour change in conjunction with physiotherapy compared with standard care (physiotherapy) in patients with chronic lower back pain (CLBP).

Design: Cost-utility and cost-effectiveness analyses alongside a multicentre controlled trial from a healthcare perspective with a 1-year time horizon.

Setting: The trial was conducted in eight centres within the Sharon district in Israel.

Participants: 220 participants aged between 25 and 55 years who suffered from CLBP for a minimum of 3 months were recruited.

Interventions: The intervention used a model of behaviour change that sought to increase the adherence and implementation of physical activity in conjunction with physiotherapy. The control arm received standard care in the form of physiotherapy.

Primary and secondary measures: The primary outcome was the incremental cost per quality-adjusted life year (QALY) of the intervention arm compared with standard care. The secondary outcome was the incremental cost per Roland-Morris Disability Questionnaire point.

Results: The cost per QALY point estimate was 10 645 New Israeli shekels (NIS) (£1737.11). There was an 88% chance the intervention was cost-effective at NIS50 000 per QALY threshold. Excluding training costs, the intervention dominated the control arm, resulting in fewer physiotherapy and physician visits while improving outcomes.

Conclusions: The enhanced transtheoretical model intervention appears to be a very cost-effective intervention leading to improved outcomes for low cost. Given limitations within this study, there is justification for examining the intervention within a larger, long-term randomised controlled trial.

Trial registration number: NCT01631344; Pre-results.

Keywords: QALYs; cost-effectiveness analysis; cost-utility analysis; economic evaluation; lower back pain; physiotherapy.

Conflict of interest statement

Competing interests: None declared.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
Net benefit by willingness to pay (New Israeli shekel, NIS) for quality-adjusted life years (QALYs).
Figure 2
Figure 2
Cost-effectiveness acceptability curve: probability intervention is cost-effective at different levels of willingness to pay (New Israeli shekel, NIS) for quality-adjusted life years (QALYs).

References

    1. Hoy D, March L, Brooks P, et al. . The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis 2014;73:968–74. 10.1136/annrheumdis-2013-204428
    1. Manchikanti L, Singh V, Falco FJE, et al. . Epidemiology of low back pain in adults. Neuromodulation: Technology at the Neural Interface 2014;17:3–10. 10.1111/ner.12018
    1. Bernstein IA, Malik Q, Carville S, et al. . Low back pain and sciatica: summary of NICE guidance. BMJ 2017;356:i6748 10.1136/bmj.i6748
    1. van Middelkoop M, Rubinstein SM, Verhagen AP, et al. . Exercise therapy for chronic nonspecific low-back pain. Best Pract Res Clin Rheumatol 2010;24:193–204. 10.1016/j.berh.2010.01.002
    1. Weiner SS, Nordin M. Prevention and management of chronic back pain. Best Pract Res Clin Rheumatol 2010;24:267–79. 10.1016/j.berh.2009.12.001
    1. Beinart NA, Goodchild CE, Weinman JA, et al. . Individual and intervention-related factors associated with adherence to home exercise in chronic low back pain: a systematic review. Spine J 2013;13:1940–50. 10.1016/j.spinee.2013.08.027
    1. Pincus T, McCracken LM. Psychological factors and treatment opportunities in low back pain. Best Pract Res Clin Rheumatol 2013;27:625–35. 10.1016/j.berh.2013.09.010
    1. Ben-Ami N, Chodick G, Mirovsky Y, et al. . Increasing Recreational Physical Activity in Patients With Chronic Low Back Pain: A Pragmatic Controlled Clinical Trial. J Orthop Sports Phys Ther 2017;47:57–66. 10.2519/jospt.2017.7057
    1. Roland M, Morris R. A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. Spine 1983;8:141–4.
    1. Ware J, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 1996;34:220–33.
    1. Shmueli A. Economic evaluation of the decisions of the Israeli Public Committee for updating the National List of Health Services in 2006/2007. Value Health 2009;12:202–6. 10.1111/j.1524-4733.2008.00435.x
    1. NICE. Guide to the methods of technology appraisal 2013: NICE, 2013.
    1. Basler HD, Bertalanffy H, Quint S, et al. . TTM-based counselling in physiotherapy does not contribute to an increase of adherence to activity recommendations in older adults with chronic low back pain--a randomised controlled trial. Eur J Pain 2007;11:31–7. 10.1016/j.ejpain.2005.12.009
    1. Ministry of Health Israel. Ministry of health price list for ambulatory and hospitalization services, 2012.
    1. YARPA. Local System Israeli Drug Catalogue: YARPA, 2012.
    1. Ministry of Health Israel. Guidelines for the submission of a request to include a pharmaceutical product in the national list of health services: Ministry of Health Pharmaceutical Administration, 2010.
    1. Brazier JE, Roberts J. The estimation of a preference-based measure of health from the SF-12. Med Care 2004;42:851–9. 10.1097/01.mlr.0000135827.18610.0d
    1. Kharroubi SA, Brazier JE, Roberts J, et al. . Modelling SF-6D health state preference data using a nonparametric Bayesian method. J Health Econ 2007;26:597–612. 10.1016/j.jhealeco.2006.09.002
    1. McCabe C, Brazier J, Gilks P, et al. . Using rank data to estimate health state utility models. J Health Econ 2006;25:418–31. 10.1016/j.jhealeco.2005.07.008
    1. Manca A, Hawkins N, Sculpher MJ. Estimating mean QALYs in trial-based cost-effectiveness analysis: the importance of controlling for baseline utility. Health Econ 2005;14:487–96. 10.1002/hec.944
    1. Deyo RA, Andersson G, Bombardier C, et al. . Outcome measures for studying patients with low back pain. Spine 1994;19:2032S–6. 10.1097/00007632-199409151-00003
    1. Jacob T, Baras M, Zeev A, et al. . Low back pain: reliability of a set of pain measurement tools. Arch Phys Med Rehabil 2001;82:735–42. 10.1053/apmr.2001.22623
    1. Gomes M, Grieve R, Nixon R, et al. . Methods for covariate adjustment in cost-effectiveness analysis that use cluster randomised trials. Health Econ 2012;21:1101–18. 10.1002/hec.2812
    1. Hoch JS, Briggs AH, Willan AR. Something old, something new, something borrowed, something blue: a framework for the marriage of health econometrics and cost-effectiveness analysis. Health Econ 2002;11:415–30. 10.1002/hec.678
    1. Hoch JS, Rockx MA, Krahn AD. Using the net benefit regression framework to construct cost-effectiveness acceptability curves: an example using data from a trial of external loop recorders versus Holter monitoring for ambulatory monitoring of “community acquired” syncope. BMC Health Serv Res 2006;6:68 10.1186/1472-6963-6-68
    1. Hoch JS, Dewa CS. Advantages of the Net Benefit Regression Framework for Economic Evaluations of Interventions in the Workplace. J Occup Environ Med 2014;56:441–5. 10.1097/JOM.0000000000000130
    1. Barber J, Thompson S. Multiple regression of cost data: use of generalised linear models. J Health Serv Res Policy 2004;9:197–204. 10.1258/1355819042250249
    1. StataCorp. Stata statistical software: release 14. College Station, TX: StataCorp LLC, 2015.
    1. Gomes M, Ng ES, Grieve R, et al. . Developing appropriate methods for cost-effectiveness analysis of cluster randomized trials. Med Decis Making 2012;32:350–61. 10.1177/0272989X11418372
    1. Fenwick E, Marshall DA, Levy AR, et al. . Using and interpreting cost-effectiveness acceptability curves: an example using data from a trial of management strategies for atrial fibrillation. BMC Health Serv Res 2006;6:52 10.1186/1472-6963-6-52
    1. Bachmann MO, Fairall L, Clark A, et al. . Methods for analyzing cost effectiveness data from cluster randomized trials. Cost Eff Resour Alloc 2007;5:12 10.1186/1478-7547-5-12
    1. Rubin DB. Multiple Imputation for Nonresponse in Surveys. John Wiley & Sons 2004.
    1. Andronis L, Kinghorn P, Qiao S, et al. . Cost-Effectiveness of Non-Invasive and Non-Pharmacological Interventions for Low Back Pain: a Systematic Literature Review. Appl Health Econ Health Policy 2017;15:173–201. 10.1007/s40258-016-0268-8
    1. Luo X, George ML, Kakouras I, et al. . Reliability, validity, and responsiveness of the short form 12-item survey (SF-12) in patients with back pain. Spine 2003;28:28 10.1097/01.BRS.0000083169.58671.96
    1. Finch AP, Dritsaki M, Jommi C. Generic preference-based measures for low back pain. Spine 2016;41:E364–74. 10.1097/BRS.0000000000001247

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