期刊
SPINE
卷 31, 期 15, 页码 1639-1645出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/01.brs.0000224528.75951.03
关键词
cost-effectiveness; back pain; self-care; randomized trial
Study Design. Two randomized, controlled trials. Objective. To evaluate the incremental cost-effectiveness of psychologist-led and lay-led interventions in reducing disability in 2 cohorts of primary care patients with back pain. Summary of Background Data. Although activating self-care interventions have been advanced as effective tools to reduce back pain-related activity limitations, few studies have evaluated the added costs of these programs relative to their added benefits. Methods. We estimated the incremental benefits and incremental costs associated with 2 self-care interventions for primary care patients with back pain. Effectiveness was measured as the number of low-impact back pain days (i.e., days when patients were satisfied with their level of back pain) over a 1-year follow-up. Costs of back-pain related services were estimated from health plan cost data. Incremental cost-effectiveness ratios were calculated for each intervention to determine the costs associated with an additional low-impact back pain day. Results. Patients assigned to the lay and psychologist interventions had a mean of 14.3 (95% confidence interval [CI] -2.7 to 30.9) and 26.2 (95% CI 9.1 - 44.4) additional low-impact back pain days, respectively, compared with patients receiving usual care. The incremental per-person costs of the lay-led and psychologist-led interventions were $139 (95% CI -$ 62.13 to $321.76) and $161 (95% CI $51.18 to $275.93), respectively. The mean cost of an additional low-impact back pain day was $9.70 for the lay-led intervention and $6.13 for the psychologist-led intervention. Conclusions. Both the lay and psychologist interventions were associated with modest improvements in outcomes but with somewhat higher costs compared to usual care.
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