Effectiveness and cost-effectiveness of adding a cognitive behavioral treatment to the rehabilitation of chronic low back pain.
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.
Schweikert
Bernd
B
GSF - National Research Center for Environment and Health, Institute of Health Economics and Health Care Management, Neuherberg. Germany. bernd.schweikert@gsf.de
Jacobi
Eckart
E
Seitz
Robert
R
Cziske
Reinhard
R
Ehlert
Antje
A
Knab
Julia
J
Leidl
Reiner
R
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