title: Effectiveness and cost-effectiveness of adding a cognitive behavioral treatment to the rehabilitation of chronic low back pain.
abstract: OBJECTIVE
  To investigate return to work and cost-effectiveness of the addition of cognitive-behavioral treatment to standard therapy compared to standard 3-week inpatient rehabilitation for patients with chronic low back pain.
  
  
  METHODS
  A prospective economic evaluation alongside a randomized controlled trial was performed. Outcomes included days off work due to spinal complaints, health-related quality of life, and direct and indirect disease-related costs.
  
  
  RESULTS
  A total of 409 patients with chronic low back pain, who were admitted to a 3-week inpatient rehabilitation, were randomly assigned to usual care or usual care plus cognitive behavioral treatment. Average incremental costs for psychological treatment during rehabilitation were Euros 127 (95% CI 125.6, 130.9; p < 0.001). Six months after rehabilitation, patients in the intervention group were absent from work an average of 5.4 (95% CI -1.4, 12.1; p = 0.12) days less than patients receiving usual treatment. Between groups, there were no significant differences in quality-adjusted life-years gained or in direct medical or nonmedical costs. The cognitive behavioral treatment showed lower indirect costs: Euros 751 (95% CI -145, 1641; p = 0.097).
  
  
  CONCLUSIONS
  Adding a cognitive behavioral component to standard therapy may reduce work days lost and thus decrease indirect costs. From a societal perspective, the cost of the psychological treatment was compensated by lower indirect costs.
authors.affiliation: GSF - National Research Center for Environment and Health, Institute of Health Economics and Health Care Management, Neuherberg. Germany. bernd.schweikert@gsf.de
authors.forename: Bernd
authors.initials: B
authors.lastname: Schweikert
authors.forename: Eckart
authors.initials: E
authors.lastname: Jacobi
authors.forename: Robert
authors.initials: R
authors.lastname: Seitz
authors.forename: Reinhard
authors.initials: R
authors.lastname: Cziske
authors.forename: Antje
authors.initials: A
authors.lastname: Ehlert
authors.forename: Julia
authors.initials: J
authors.lastname: Knab
authors.forename: Reiner
authors.initials: R
authors.lastname: Leidl
mesh_terms: D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy / Q000191:economics*; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D004651:Employment; D017048:Health Care Costs; D006801:Humans; D017116:Low Back Pain / Q000503:physiopathology / Q000523:psychology* / Q000534:rehabilitation*; D011446:Prospective Studies; D011788:Quality of Life; D018582:Sick Leave; D016896:Treatment Outcome