Cost-effectiveness of two self-care interventions to reduce disability associated with back pain.
METHODS
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.


BACKGROUND
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 dollar 139 (95% CI - dollar 62.13 to dollar 321.76) and dollar 161 (95% CI dollar 51.18 to dollar 275.93), respectively. The mean cost of an additional low-impact back pain day was dollar 9.70 for the lay-led intervention and dollar 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.
Strong
Larkin L
LL
Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, WA, USA. Lstrong@u.washington.edu
Von Korff
Michael
M
Saunders
Kathleen
K
Moore
James E
JE
D000328:Adult; D000368:Aged; D001416:Back Pain / Q000191:economics* / Q000523:psychology* / Q000628:therapy; D003362:Cost-Benefit Analysis; D006233:Persons with Disabilities / Q000523:psychology* / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D008875:Middle Aged; D010379:Peer Group; D011320:Primary Health Care / Q000191:economics* / Q000379:methods / Q000458:organization & administration; D015397:Program Evaluation; D011584:Psychology / Q000191:economics / Q000379:methods / Q000458:organization & administration; D012648:Self Care / Q000191:economics* / Q000523:psychology; D016896:Treatment Outcome