title: Is exposure in vivo cost-effective for chronic low back pain? A trial-based economic evaluation.
abstract: BACKGROUND
  Back pain is one of the most expensive health complaints. Comparing the economic aspects of back pain interventions may therefore contribute to a more efficient use of available resources. This study reports on a long-term cost-effectiveness analysis (CEA) and cost-utility analysis (CUA) of two treatments as viewed from a societal perspective: 1) exposure in vivo treatment (EXP), a recently developed cognitive behavioral treatment for patients with chronic low back pain who have elevated pain-related fear and 2) the more commonly used graded activity (GA) treatment.
  
  
  METHODS
  Sixty-two patients with non-specific chronic low back pain received either EXP or GA. Primary data were collected at four participating treatment centers in the Netherlands. Primary outcomes were self-reported disability (for the CEA) and quality-adjusted life years (for the CUA). Program costs, health care utilization, patient and family costs, and production losses were measured by analyzing therapy records and cost diaries. Data was gathered before, during, and after treatment, and at 6 and 12 months after treatment. Non-parametric bootstrap analyses were used to quantify the uncertainty concerning the cost-effectiveness ratio. In addition, cost-effectiveness planes and cost-effectiveness acceptability curves were performed.
  
  
  RESULTS
  EXP showed a tendency to reduce disability, increase quality adjusted life years and decrease costs compared to GA. The incremental cost-effectiveness ratios of both the CEA and CUA are in favor of EXP.
  
  
  CONCLUSIONS
  Based on these results, implementing EXP for this group of patients seems to be the best decision.
  
  
  BACKGROUND
  ISRCTN88087718.
authors.affiliation: Department of Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. marielle.goossens@maastrichtuniversity.nl.|CAPHRI - School for Public Health and Primary Care, Department of Rehabilitation Research, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. marielle.goossens@maastrichtuniversity.nl.
authors.forename: Marielle E J B
authors.initials: ME
authors.lastname: Goossens
authors.affiliation: CAPHRI - School for Public Health and Primary Care, Department of Health Services Research, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. reina.dekinderen@maastrichtuniversity.nl.
authors.forename: Reina J A
authors.initials: RJ
authors.lastname: de Kinderen
authors.affiliation: Adelante, Rehabilitation Foundation Hoensbroek, Zandbergseweg 111, 6432 CC, Hoensbroek, The Netherlands. m.leeuw@adelante-zorggroep.nl.
authors.forename: Maaike
authors.initials: M
authors.lastname: Leeuw
authors.affiliation: CAPHRI - School for Public Health and Primary Care, Department of Rehabilitation Research, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. jeroen.de.jong@mumc.nl.|Department of Rehabilitation, Maastricht University Medical Center, Maastricht, The Netherlands. jeroen.de.jong@mumc.nl.
authors.forename: Jeroen R
authors.initials: JR
authors.lastname: de Jong
authors.affiliation: Department of Rehabilitation, Maastricht University Medical Center, Maastricht, The Netherlands. j.ruijgrok@maastrichtuniversity.nl.
authors.forename: Joop
authors.initials: J
authors.lastname: Ruijgrok
authors.affiliation: CAPHRI - School for Public Health and Primary Care, Department of Health Services Research, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. s.evers@maastrichtuniversity.nl.|Trimbos Institute, Netherlands Institute of Mental Health and Addiction, P.O. Box 725, 3500 AS, Utrecht, The Netherlands. s.evers@maastrichtuniversity.nl.
authors.forename: Silvia M A A
authors.initials: SM
authors.lastname: Evers
authors.affiliation: Department of Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. johannes.vlaeyen@psy.kuleuven.be.|Health Psychology Research Group, University of Leuven, Tiensestraat 102, 3000, Leuven, Belgium. johannes.vlaeyen@psy.kuleuven.be.
authors.forename: Johan W S
authors.initials: JW
authors.lastname: Vlaeyen
mesh_terms: D000328:Adult; D059350:Chronic Pain / Q000191:economics* / Q000523:psychology / Q000628:therapy; D015928:Cognitive Behavioral Therapy / Q000191:economics; D003362:Cost-Benefit Analysis; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D017116:Low Back Pain / Q000191:economics* / Q000523:psychology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D019057:Quality-Adjusted Life Years