• Spine · Aug 2010

    Randomized Controlled Trial Comparative Study

    Low back pain in primary care: costs of care and prediction of future health care utilization.

    • Annette Becker, Heiko Held, Marcus Redaelli, Konstantin Strauch, Jean F Chenot, Corinna Leonhardt, Stefan Keller, Erika Baum, Michael Pfingsten, Jan Hildebrandt, Heinz-Dieter Basler, Michael M Kochen, and Norbert Donner-Banzhoff.
    • Department of General Practice, Preventive, and Rehabilitation Medicine, University of Marburg, Marburg, Germany. annette.becker@staff.uni-marburg.de
    • Spine. 2010 Aug 15; 35 (18): 1714-20.

    Study DesignCost of illness study alongside a randomized controlled trial.ObjectiveTo describe the costs of care for patients with low back pain (1) and to identify patient characteristics as predictors for high health care cost during a 1-year follow-up (2).Summary Of Background DataLow back pain (LBP) is one of the leading causes of high health care costs in industrialized countries (Life time prevalence, 70%). A lot of research has been done to improve primary health care and patients' prognosis. However, the cost of health care does not necessarily follow changes in patient outcomes.MethodsGeneral practitioners (n = 126) recruited 1378 patients consulting for LBP. Sociodemographic data, pain characteristics, and LBP-related cost data were collected by interview at baseline and after 6 and 12 months. Costs were evaluated from the societal perspective. Predictors of high cost during the subsequent year were studied using logistic regression analysis.ResultsMean direct and indirect costs for LBP care are about twice as high for patients with chronic LBP compared to acutely ill patients. Indirect costs account for more than 52% to 54% of total costs. About 25% of direct costs refer to therapeutic procedures and hospital or rehabilitational care. Patients with high disability and limitations in daily living show a 2- to 5-fold change for subsequent high health care costs. Depression seems to be highly relevant for direct health care utilization.ConclusionInterventions designed to reduce high health care costs for LBP should focus on patients with severe LBP and depressive comorbidity. Our results add to the economic understanding of LBP care and may give guidance for future actions on health care improvement and cost reduction.

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