Is an enhanced behaviour change intervention cost-effective compared with physiotherapy for patients with chronic low back pain? Results from a multicentre trial in Israel.

Content Provider	Europe PMC
Author	Canaway, Alastair Pincus, Tamar Underwood, Martin Shapiro, Yair Chodick, Gabriel Ben-Ami, Noa
Copyright Year	2018
Abstract	ObjectiveTo assess the cost-effectiveness of an enhanced transtheoretical model of behaviour change in conjunction with physiotherapy compared with standard care (physiotherapy) in patients with chronic lower back pain (CLBP).DesignCost-utility and cost-effectiveness analyses alongside a multicentre controlled trial from a healthcare perspective with a 1-year time horizon.SettingThe trial was conducted in eight centres within the Sharon district in Israel.Participants220 participants aged between 25 and 55 years who suffered from CLBP for a minimum of 3 months were recruited.InterventionsThe intervention used a model of behaviour change that sought to increase the adherence and implementation of physical activity in conjunction with physiotherapy. The control arm received standard care in the form of physiotherapy.Primary and secondary measuresThe primary outcome was the incremental cost per quality-adjusted life year (QALY) of the intervention arm compared with standard care. The secondary outcome was the incremental cost per Roland-Morris Disability Questionnaire point.ResultsThe cost per QALY point estimate was 10 645 New Israeli shekels (NIS) (£1737.11). There was an 88% chance the intervention was cost-effective at NIS50 000 per QALY threshold. Excluding training costs, the intervention dominated the control arm, resulting in fewer physiotherapy and physician visits while improving outcomes.ConclusionsThe enhanced transtheoretical model intervention appears to be a very cost-effective intervention leading to improved outcomes for low cost. Given limitations within this study, there is justification for examining the intervention within a larger, long-term randomised controlled trial.Trial registration numberNCT01631344; Pre-results.
Journal	BMJ Open
Volume Number	8
PubMed Central reference number	PMC5898302
Issue Number	4
PubMed reference number	29643158
e-ISSN	20446055
DOI	10.1136/bmjopen-2017-019928
Language	English
Publisher	BMJ Publishing Group
Publisher Date	2018-04-10
Publisher Place	London
Access Restriction	Open
Rights License	This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Subject Keyword	lower back pain economic evaluation QALYs cost-utility analysis cost-effectiveness analysis physiotherapy
Content Type	Text
Resource Type	Article
Subject	Medicine