Implementing stratified primary care management for low back pain: cost-utility analysis alongside a prospective,
David G T Whitehurst1, Stirling Bryan, Martyn Lewis
1*Faculty of Health Sciences, Blusson Hall, Simon Fraser University, Burnaby, British Columbia, Canada †Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada ‡School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada §Arthritis Research UK Primary Care Centre, Institute for Primary Care and Health Sciences, Keele University, Staffordshire, United Kingdom; and ¶Department of Public Health & Primary Care, Primary Care Unit, University of Cambridge, United Kingdom.
Stratified care for low back pain (LBP) is cost-effective for high-risk patients, offering savings and improved quality-adjusted life years (QALYs). For low and medium-risk groups, cost-effectiveness is uncertain, with limited impact on work absence.
Area of Science:
- Health Economics
- Clinical Practice Guidelines
- Musculoskeletal Disorders
Background:
- Low back pain (LBP) poses a significant health and economic burden.
- Current management often involves usual care, with variable outcomes.
- Stratified care aims to personalize treatment based on risk of persistent pain.
Purpose of the Study:
- To evaluate the cost-utility of stratified care versus usual care for LBP in general practice.
- To compare cost-effectiveness across patient subgroups defined by risk of persistent disabling pain.
- To assess societal costs, including work absence, associated with different care strategies.
Main Methods:
- A within-study cost-utility analysis was conducted.
- Individual-level data from prospective patient cohorts with 6-month follow-up were used.
- Quality-adjusted life years (QALYs) were derived from EQ-5D responses; uncertainty was assessed using cost-utility planes and acceptability curves.
Main Results:
- Stratified care was dominant for high-risk LBP patients, yielding cost savings (£124) and improved QALYs (0.023).
- Cost-effectiveness for low and medium-risk patients was below 60% likelihood, regardless of willingness-to-pay.
- Stratified care reduced work absence by 6 days for medium and high-risk employed patients, with societal cost savings.
Conclusions:
- Stratified care for LBP is cost-effective only for patients identified as high risk for persistent disabling pain.
- Adherence to screening tool recommendations for matched treatments is crucial for cost-effectiveness.
- The findings support targeted implementation of stratified care in primary care settings.
