THE EFFICIENCY OF TREATMENT FOR BACK PAIN IN SPAIN
Title.
Cost/effectiveness of different management
strategies for low back pain used in Spain.
Background.
Currently, it is not known how physicians
treat their patients with low back pain, therefore the relationship
between the costs this management entails and the outcome
it obtains (that is to say, its efficiency and within that,
specifically its "cost/effectiveness") is also not
known.
Additionally, and due to data that suggest that this management
is not homogeneous, the cost/effectiveness of the different
management strategies used should be compared.
Objectives.
-
To describe the clinical evolution of patients with low
back pain and to calculate the health care and labor costs
they generate during the study period.
-
To describe the outcomes ("effectiveness")
of each kind of treatment strategy and its efficiency
(relation between its cost and effectiveness, and between
its cost and the improvement in the quality of life its
use entails).
Methodology.
It was a cross-sectional (descriptive) study.
The study was carried out with a convenience sample of 692
patients who consulted one of the 105 doctors at the 39 Primary
Care Centers that participated in the study for low back pain
(with or without referred pain).
The patients' evolution was evaluated in terms of the evolution
of their pain (assessed by means of a visual analog scale
and separately for low back pain and the referred or radiated
pain), their degree of disability (measured by the Spanish
version of the Roland-Morris scale) and their quality of life
(measured by means of the EuroQol scale). To calculate the
costs, health care costs (derived from the use of services,
diagnostic tests and prescribed treatments) and labor costs
(derived from sick leave and work disability caused by the
low back pain) were included.
The clinical assessments and use of services were made when
the patient was included in the study, at 15 days and at 60
days, and afterwards on demand until the period under study
ended. The additional costs the patients incurred could not
be assessed (it was considered unviable to use a "cost
diary" so that costs such as those from the sale of medication
in pharmacies that the patients did not report or the possible
payment to persons for housekeeping services since the low
back pain prevented performing them or the lucrum cesans (due
to the reduction in productivity of those patients with low
back pain who continued working) were not considered. Hence
the total overall costs could be undervalued, however it was
not considered viable to collect that data.
The analysis of the data determined the effectiveness of
the different management strategies observed, as well as their
costs and their cost/effectiveness.
Participants, along with the Foundation's
Science Department.
106 researchers from 40 Primary Care centers
and Primary Care Research Units in Badajoz, Baleares, Bilbao,
Burgos, Cáceres, Cuenca, Guadalajara, Huesca, Madrid,
Murcia, Palencia, Valencia, as well as the Unit of Clinical
Biostatistics of the Hospital Ramón y Cajal, Madrid;
all of them members of the Spanish Network of Researchers
on Back Problems.
Co-funded by Kovacs Foundation and the Fund for Health Research
of the Spanish Ministry of Health and Consumer Services.
Status.
Data collection has been completed and data is currently
being analyzed.
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