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Can cost utility evaluations inform decision making about interventions for low back pain?
Simon Dagenais1, Darren M Roffey, Eugene K Wai
1Department of Epidemiology and Community Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5 Canada. simon@spine-research.com
The Spine Journal : Official Journal of the North American Spine Society
|September 15, 2009
Summary
This systematic review found few cost utility analyses (CUAs) for low back pain (LBP) interventions. Current CUAs lack sufficient detail for decision-making, highlighting a need for improved methodology in future economic evaluations of LBP treatments.
Area of Science:
- Health Economics
- Evidence-Based Medicine
- Musculoskeletal Disorders
Background:
- Low back pain (LBP) is a significant cause of healthcare utilization and lost productivity.
- Many LBP interventions lack strong supporting evidence.
- Cost utility analyses (CUAs) can inform healthcare decision-making for LBP.
Purpose of the Study:
- To systematically review existing cost utility analyses (CUAs) for interventions targeting low back pain (LBP).
Main Methods:
- Systematic review of randomized controlled trials with associated CUAs for LBP.
- Searches conducted in MEDLINE using specific keywords and subject headings.
- Inclusion criteria excluded studies before 1998, non-English, decision analyses, and duplicates.
Main Results:
- Fifteen eligible CUAs were identified from 319 citations.
- Most studies focused on chronic LBP or radiculopathy with follow-up >12 months.
- Cost per quality-adjusted life year (QALY) varied widely, with a median of $13,015.
Conclusions:
- A significant heterogeneity exists in interventions, cost components, and methods across identified CUAs.
- Current CUAs for LBP do not provide adequate information for decision-makers.
- Future CUAs should comprehensively measure direct and indirect costs, ensure sufficient follow-up, and report methods clearly.
