title: Cost-effectiveness of providing patients with information on managing mild low-back symptoms in an occupational health setting.
abstract: BACKGROUND
  Evidence shows that low back specific patient information is effective in sub-acute low back pain (LBP), but effectiveness and cost-effectiveness (CE) of information in early phase symptoms is not clear. We assessed effectiveness and CE of patient information in mild LBP in the occupational health (OH) setting in a quasi-experimental study.
  
  
  METHODS
  A cohort of employees (N = 312, aged <57) with non-specific, mild LBP (Visual Analogue Scale between 10-34 mm) was selected from the respondents of an employee survey (N = 2480; response rate 71 %). A random sample, representing the natural course of LBP (NC, N = 83; no intervention), was extracted as a control group. Remaining employees were invited (181 included, 47 declined, one excluded) into a randomised controlled study with two 1:1 allocated parallel intervention arms ("Booklet", N = 92; "Combined", N = 89). All participants received the "Back Book" patient information booklet and the Combined also an individual verbal review of the booklet. Physical impairment (PHI), LBP, health care (HC) utilisation, and all-cause sickness absence (SA) were assessed at two years. CE of the interventions on SA days was analysed by using direct HC costs in one year, two years from baseline. Multiple imputation was used for missing values.
  
  
  RESULTS
  Compared to NC, the Booklet reduced HC costs by 196€ and SA by 3.5 days per year. In 81 % of the bootstrapped cases the Booklet was both cost saving and effective on SA. Compared to NC, in the Combined arm, the figures were 107€, 0.4 days, and 54 %, respectively. PHI decreased in both interventions.
  
  
  CONCLUSIONS
  Booklet information alone was cost-effective in comparison to natural course of mild LBP. Combined information reduced HC costs. Both interventions reduced physical impairment. Mere booklet information is beneficial for employees who report mild LBP in the OH setting, and is also cost saving for the health care system.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00908102.
authors.affiliation: Finnish Institute of Occupational Health (FIOH), P.B. 40, 00251, Helsinki, Finland. jarmo.rantonen@fimnet.fi.|Hjelt Institute, Department of Public Health, University of Helsinki, Helsinki, Finland. jarmo.rantonen@fimnet.fi.|South Karelian Institute, Lappeenranta University of Technology, Lappeenranta, Finland. jarmo.rantonen@fimnet.fi.|University of Helsinki, Helsinki, Finland. jarmo.rantonen@fimnet.fi.
authors.forename: J
authors.initials: J
authors.lastname: Rantonen
authors.affiliation: Finnish Institute of Occupational Health (FIOH), P.B. 40, 00251, Helsinki, Finland.|Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
authors.forename: J
authors.initials: J
authors.lastname: Karppinen
authors.affiliation: Helsinki Institute for Information Technology HIIT, Department of Computer Science, Aalto University, Espoo, Finland.
authors.forename: A
authors.initials: A
authors.lastname: Vehtari
authors.affiliation: Department of Physical Medicine and Rehabilitation, South Karelia Social and Health Care District, Lappeenranta, Finland.
authors.forename: S
authors.initials: S
authors.lastname: Luoto
authors.affiliation: Finnish Institute of Occupational Health (FIOH), P.B. 40, 00251, Helsinki, Finland.
authors.forename: E
authors.initials: E
authors.lastname: Viikari-Juntura
authors.affiliation: Department of Physical Medicine and Rehabilitation, South Karelia Social and Health Care District, Lappeenranta, Finland.
authors.forename: M
authors.initials: M
authors.lastname: Hupli
authors.affiliation: National Institute for Health and Welfare, Centre for Health and Social Economics, Helsinki, Finland.
authors.forename: A
authors.initials: A
authors.lastname: Malmivaara
authors.affiliation: Evalua International, Espoo, Finland.|Hjelt Institute, Department of Public Health, University of Helsinki, Helsinki, Finland.
authors.forename: S
authors.initials: S
authors.lastname: Taimela
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D017116:Low Back Pain / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D016272:Occupational Health / Q000191:economics*; D010174:Pamphlets; D010353:Patient Education as Topic / Q000191:economics* / Q000379:methods; D018582:Sick Leave / Q000706:statistics & numerical data
keywords: Cohort study; Disability; Health economy; Intervention; Low back pain; Prevention; Quasi-experimental study; RCT; Sickness absence; The Back Book