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Effect of integrated care for sick listed patients with chronic low back pain: economic evaluation alongside a randomised controlled trial [with consumer summary]
Lambeek LC, Bosmans JE, van Royen BJ, van Tulder MW, van Mechelen W, Anema JR
BMJ 2010 Nov 30;341:c6414
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To evaluate the cost effectiveness, cost utility, and cost-benefit of an integrated care programme compared with usual care for sick listed patients with chronic low back pain. DESIGN: Economic evaluation alongside a randomised controlled trial with 12 months' follow-up. SETTING: Primary care (10 physiotherapy practices, one occupational health service, one occupational therapy practice) and secondary care (five hospitals) in the Netherlands, 2005 to 2009. PARTICIPANTS: 134 adults aged 18 to 65 sick listed because of chronic low back pain: 66 were randomised to integrated care and 68 to usual care. INTERVENTIONS: Integrated care consisted of a workplace intervention based on participatory ergonomics, with involvement of a supervisor, and a graded activity programme based on cognitive behavioural principles. Usual care was provided by general practitioners and occupational physicians according to Dutch guidelines. MAIN OUTCOME MEASURES: The primary outcome was duration until sustainable return to work. The secondary outcome was quality adjusted life years (QALYs), measured using EuroQol. RESULTS: Total costs in the integrated care group (Great British Pounds 13,165, SD 13,600) were significantly lower than in the usual care group (Great British Pounds 18,475, SD 13,616). Cost effectiveness planes and acceptability curves showed that integrated care was cost effective compared with usual care for return to work and QALYs gained. The cost-benefit analyses showed that every pound invested in integrated care would return an estimated Great British Pounds 26. The net societal benefit of integrated care compared with usual care was Great British Pounds 5,744. CONCLUSIONS: Implementation of an integrated care programme for patients sick listed with chronic low back pain has a large potential to significantly reduce societal costs, increase effectiveness of care, improve quality of life, and improve function on a broad scale. Integrated care therefore has large gains for patients and society as well as for employers.
Reproduced with permission from the BMJ Publishing Group.

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