Economic evaluation of an intensive group training protocol compared with usual care physiotherapy in patients with chronic low back pain.
METHODS
Economic evaluation from a societal perspective conducted alongside a randomized controlled trial with a follow-up of 52 weeks.


OBJECTIVE
To evaluate the cost effectiveness and cost utility of an intensive group training protocol compared with usual care physiotherapy in patients with nonspecific chronic low back pain. The intensive group training protocol combines exercise therapy, back school, and behavioral principles.


BACKGROUND
Two studies found a significant reduction in absenteeism for a graded activity program in occupational health care. This program has not yet been evaluated in a primary care physiotherapy setting.


METHODS
Participating physical therapists in primary care recruited 114 patients with chronic nonspecific low back pain. Eligible patients were randomized to either the protocol group or the guideline group. Outcome measures included functional status (Roland Morris Disability Questionnaire), pain intensity (11-point numerical rating scale), general perceived effect and quality of life (EuroQol-5D). Cost data were measured with cost diaries and included direct and indirect costs related to low back pain.


RESULTS
After 52 weeks, the direct health care costs were significantly higher for patients in the protocol group, largely due to the costs of the intervention. The mean difference in total costs amounted to [Euro sign] 233 (95% confidence interval: [Euro sign] -2.185; [Euro sign] 2.764). The cost-effectiveness planes indicated no significant differences in cost effectiveness between the 2 groups.


CONCLUSIONS
The results of this economic evaluation showed no difference in total costs between the protocol group and the guideline group. The differences in effects were small and not statistically significant. At present, national implementation of the protocol is not recommended.
van der Roer
Nicole
N
EMGO-Institute, VU University Medical Center, Amsterdam, The Netherlands.
van Tulder
Maurits
M
van Mechelen
Willem
W
de Vet
Henrica
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D032763:Behavior Control / Q000379:methods; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D005081:Exercise Therapy / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D017116:Low Back Pain / Q000191:economics* / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010147:Pain Measurement; D026741:Physical Therapy Modalities / Q000191:economics*; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome