Cost-effectiveness of an active implementation strategy for the Dutch physiotherapy guideline for low back pain

Background and purpose: The treatment for patients with low back pain varies considerably. The Dutch Physiotherapy Association issued an evidence-based physiotherapy guideline for non-specific low back pain. To establish changes in daily practice an active implementation strategy was developed. We evaluated the cost-effectiveness of this implementation strategy. Subjects: 113 physiotherapists included 500 patients with low back pain. Methods: In the intervention group the guideline was implemented actively, in the control group the standard method of dissemination was used. The patients filled in questionnaires at baseline and 6, 12, 26 and 52 weeks later. Direct medical costs, productivity costs (due to absenteeism) and quality of life (EQ-5D) were calculated. Results: During the I-year follow up, no differences were found in the quality of life, direct medical costs and productivity costs. Conclusion: The active implementation strategy appears not to be cost effective as compared to the standard strategy. (c) 2005 Elsevier Ireland Ltd. All rights reserved.