The economic impact of a physician-introduced web portal on lower back pain: results from a cluster-randomized trial
Klaus Kaier1, Christian Schlett2, Piet van der Keylen3,4
1Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. klaus.kaier@gmail.com.
Background:
Low back pain (LBP) is a prevalent condition that imposes a significant economic burden on healthcare systems. Digital health interventions, such as the web-based tala-med platform, offer an evidence-based approach to patient education and shared decision-making. This study evaluates the financial and cost-effectiveness implications of integrating tala-med into primary care compared to routine care.
Methods:
This multi-center, cluster-randomized trial assigned primary care practices (PCPs) in Germany to either an intervention group (IG) using tala-med or a control group (CG) providing routine care. Patients aged ≥ 18 with LBP were recruited and health economic evaluation included a claims-data-based cost analysis of back pain-related healthcare utilization for a three month follow-up. Cost-effectiveness was assessed by comparing additional costs per unit increase in self-reported knowledge and perceived informedness. LBP knowledge ranged from 1 (very low) to 5 (very high) and LBP informedness ranged from 1 (not at all) to 5 (very good). Sensitivity analyses included also non-back-pain related healthcare utilization and restricted the analysis to a sub-cohort of currently employed patients.
Results:
Data from 183 intervention and 133 control patients were analysed. The intervention group demonstrated fewer general practitioner (risk-adjusted incidence rate ratio (IRR): 0.86, p = 0.284) and specialist contacts (IRR 0.70, p = 0.009), but significantly more back pain-related sick leave (IRR 8.73, p = 0.001). The adjusted increase in back pain-related costs in the IG was €822.22 (p = 0.005). Sensitivity analyses showed minimal impact on total healthcare costs (€145.88, p = 0.819). Cost-effectiveness analysis indicated additional costs of €3328.54 per unit increase in self-reported knowledge and €1611.21 per unit increase in perceived informedness.
Discussion:
While tala-med use was associated with increased back pain-related costs, total healthcare expenditures remained stable. The reasons for the discrepancy remain unclear but may include increased awareness of LBP or extended recovery periods facilitated by sick leave. Further research is needed to validate these findings and explore the long-term benefits of digital health interventions in LBP management.
