Cost-effectiveness of a classification-based system for sub-acute and chronic low back pain

Abstract

Purpose: Identifying relevant subgroups in patients with low back pain (LBP) is considered important to guide physical therapy practice and to improve outcomes. The aim of the present study was to assess the cost-effectiveness of a modified version of Delitto's classification-based treatment approach compared with usual physical therapy care in patients with sub-acute and chronic LBP with 1 year follow-up.

Methods: All patients were classified using the modified version of Delitto's classification-based system and then randomly assigned to receive either classification-based treatment or usual physical therapy care. The main clinical outcomes measured were; global perceived effect, intensity of pain, functional disability and quality of life. Costs were measured from a societal perspective. Multiple imputations were used for missing data. Uncertainty surrounding cost differences and incremental cost-effectiveness ratios was estimated using bootstrapping. Cost-effectiveness planes and cost-effectiveness acceptability curves were estimated.

Results: In total, 156 patients were included. The outcome analyses showed a significantly better outcome on global perceived effect favoring the classification-based approach, and no differences between the groups on pain, disability and quality-adjusted life-years. Mean total societal costs for the classification-based group were <euro>2,287, and for the usual physical therapy care group <euro>2,020. The difference was <euro>266 (95% CI <euro>-720 to <euro>1,612) and not statistically significant. Cost-effectiveness analyses showed that the classification-based approach was not cost-effective in comparison with usual physical therapy care for any clinical outcome measure.

Conclusion: The classification-based treatment approach as used in this study was not cost-effective in comparison with usual physical therapy care in a population of patients with sub-acute and chronic LBP.

Fig. 1

The classification-based system for patients with LBP (>6 weeks) as used in this RCT

Fig. 2

Cost-effectiveness plane and cost-effectiveness acceptability curve for classification-based treatment in comparison with usual physical therapy care for global perceived effect after 12 months (multiple imputed data)

Fig. 3

Cost-utility plane and cost-utility acceptability curve for classification-based treatment in comparison with usual physical therapy care after 12 months (multiple imputed data)