Cost-effectiveness of a classification-based treatment system for sub-acute and chronic low back pain in primary care

Cost-effectiveness of a classification-based treatment system for sub-acute and chronic low back pain in primary care. Eur Spine J. Abstract Purpose: Identifying relevant subgroups in patients with low back pain (LBP) is considered important to guide physical therapy practice and to improve outcomes. The aim of the present study was to assess the cost-effectiveness of a modified version of Delitto's classification-based treatment approach compared with usual physical therapy care in patients with sub-acute and chronic LBP with one year follow-up. Methods: All patients were classified using the modified version of Delitto's classification and then randomly assigned to receive either classification-based treatment or usual physical therapy care. The main clinical outcomes measured were; global perceived effect, intensity of pain, functional disability and quality of life. Costs were measured from a societal perspective. Multiple imputation was used for missing data. Uncertainty surrounding cost differences and incremental cost-effectiveness ratios was estimated using bootstrapping. Cost-effectiveness planes and cost-effectiveness acceptability curves were estimated. Results: In total, 156 patients were included. The outcome analyses showed a significantly better outcome on global perceived effect favoring the classification-based approach, and no differences between the groups on pain, disability and QALY's. Mean total societal costs for the classification-based group were €2287, and for usual physical therapy care €2020. The difference was €266 (95% CI-€720 to €1612) and not statistically significant. Cost-effectiveness analyses showed that the classification-based approach was not cost-effective in comparison with usual physical therapy care for any clinical outcome measure. Conclusion: The classification-based approach as used in this study was not cost-effective in comparison with usual physical therapy care in a population of patients with sub-acute and chronic LBP in primary care.