title: The economic burden of guideline-recommended first line care for acute low back pain.
abstract: To report health care costs and the factors associated with such costs in people with acute low back pain receiving guideline-recommended first line care.
  
  
  
  This is a secondary analysis of a trial which found no difference in clinical outcomes. Participants with acute low back pain received reassurance and advice, and either paracetamol (taken regularly or as needed) or placebo for up to 4 weeks and followed up for 12 weeks. Data on health service utilisation were collected by self-report. A health sector perspective was adopted to report all direct costs incurred (in 2015 AUD, 1 AUD = 0.53 Euro). Costs were reported for the entire study cohort and for each group. Various baseline clinical, demographic, work-related and socioeconomic factors were investigated for their association with increased costs using generalised linear models.
  
  
  
  The mean cost per participant was AUD167.74 (SD = 427.24) for the entire cohort (n = 1365). Most of these costs were incurred in primary care through visits to a general practitioner or physiotherapist. Compared to the placebo group, there was an increase in cost when paracetamol was taken. Multivariate analysis showed that disability, symptom duration and compensation were associated with costs. Receiving compensation was associated with a twofold increase compared to not receiving compensation.
  
  
  
  Taking paracetamol as part of first line care for acute low back pain increased the economic burden. Higher disability, longer symptom duration and receiving compensation were independently associated with increased health care costs.
authors.affiliation: The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia. clin@georgeinstitute.org.au.
authors.forename: Chung-Wei Christine
authors.initials: CC
authors.lastname: Lin
authors.affiliation: The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Li
authors.affiliation: Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Williams
authors.affiliation: The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Maher
authors.affiliation: St Vincent's Hospital Clinical School and Pharmacology, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Richard O
authors.initials: RO
authors.lastname: Day
authors.affiliation: Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Hancock
authors.affiliation: The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Latimer
authors.affiliation: Faculty of Pharmacy and Centre for Education and Research on Ageing, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Mclachlan
authors.affiliation: The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Jan
mesh_terms: D000082:Acetaminophen / Q000191:economics* / Q000627:therapeutic use; D059787:Acute Pain / Q000188:drug therapy / Q000191:economics*; D000328:Adult; D001315:Australia; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D017116:Low Back Pain / Q000188:drug therapy / Q000191:economics*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D012959:Socioeconomic Factors
chemical_list: D000082:Acetaminophen
keywords: Costs and cost analysis; Health care costs; Low back pain; Paracetamol