Systematic review of the cost-effectiveness of implementing guidelines on low back pain management in primary care: is transferability to other countries possible?
The primary aim is to identify, summarise and quality assess the available literature on the cost-effectiveness of implementing low back pain guidelines in primary care. The secondary aim is to assess the transferability of the results to determine whether the identified studies can be included in a comparison with a Danish implementation study to establish which strategy procures most value for money.



Systematic review.



The search was conducted in Embase, PubMed, Cochrane Library, NHS Economic Evaluation Database, Scopus, CINAHL and EconLit. No restrictions were made concerning language, year of publication or publication type. The bibliographies of the included studies were searched for any studies not captured in the literature search.



To be included, a study must be: (1) based on a randomised controlled trial comparing implementation strategies, (2) the guideline must concern treatment of low back pain in primary care and (3) the economic evaluation should contain primary data on cost and cost-effectiveness.



The title and abstract were assessed for 308 studies; of these, three studies were found eligible for inclusion. The Consensus Health Economic Criteria (CHEC) list showed that the 3 studies were of moderate methodological quality while application of Welte's model showed that cost results from two studies could, with adjustments, be transferred to a Danish setting. It was questionable whether the associated effects could be transferred.



Despite the resemblance of the implementation strategies, the 3 studies report conflicting results on cost-effectiveness. This review showed that transferring the results from the identified studies is not straightforward and underlines the importance of transparent reporting. Future research should focus on transferability of effects, for example, development of a supplement to Welte's model.
Faculty of Social Sciences, Danish Center for Healthcare Improvements, Aalborg University, Aalborg, Denmark.
Cathrine Elgaard
CE
Jensen
Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Martin Bach
MB
Jensen
Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Allan
0000-0002-7009-3025
A
Riis
Faculty of Social Sciences, Danish Center for Healthcare Improvements, Aalborg University, Aalborg, Denmark.
Karin Dam
KD
Petersen
D003362:Cost-Benefit Analysis; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D059408:Pain Management / Q000191:economics*; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000458:organization & administration; D016032:Randomized Controlled Trials as Topic
Guideline implementation; HEALTH ECONOMICS; Low back pain; Primary health care; Transferability