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Cost-effectiveness of a team-based integrative medicine approach to the treatment of back pain


Wayne, Peter M; Buring, Julie E; Eisenberg, David M; Osypiuk, Kamila; Gow, Brian J; Davis, Roger B; Witt, Claudia M; Reinhold, Thomas (2019). Cost-effectiveness of a team-based integrative medicine approach to the treatment of back pain. Journal of Alternative and Complementary Medicine, 25(S1):S138-S146.

Abstract

OBJECTIVES:
To report the results of health economic analyses comparing two treatment approaches for chronic low back pain (CLBP).
DESIGN:
Observational prospective cohort study comparing effectiveness and cost-effectiveness of CLBP care provided at an integrative care clinic with that provided in other clinics within the same hospital. CLBP-related medical utilization, function, quality of life, and days of work incapacity were self-reported at baseline, 3, 6, and 12 months.
SETTINGS/LOCATION:
Osher Clinical Center (OCC) based at a tertiary academic hospital (Brigham and Women's Hospital [BWH]) and other clinics at BWH.
SUBJECTS:
CLBP patients seeking care at OCC or non-OCC BWH clinics.
INTERVENTIONS:
Integrative or conventional care for CLBP as prescribed by the treating clinician(s).
OUTCOME MEASURES:
Quality-adjusted life years (QALYs) were estimated per treatment approach based on the SF-12. Cost per QALY gained was evaluated using an incremental cost-effectiveness ratio (ICER). ICERs based on CLBP-specific effectiveness measures (Roland Disability Questionnaire [RDQ] and bothersomeness of pain [BOP]) were exploratory outcomes.
RESULTS:
Total adjusted annual CLBP-related costs per patient were greater in the OCC versus non-OCC group ($11,526.73 vs. $6,810.63). Between group differences in QALYs were small and ICER estimate of cost per QALY gained was high ($436,676). However, unadjusted mean direct costs per patient decreased over time in the OCC group. Savings in direct costs of $391 (95% confidence interval: -1,078 to 1,861) were observed in the OCC group for the 6- to 12-month period, driven primarily by reduced medication usage. ICERs based on adjusted RDQ and BOP group differences showed cost of $2,073 and $4,203 for a one-point reduction per respective scale.
CONCLUSIONS:
When adjusted for baseline differences, self-reported costs were higher in the OCC group with only small effects on QALYs. However, trends toward decreased direct expenditures and medication usage over time warrant further investigation. Future studies evaluating potential benefits of integrative care models for the management of CLBP should employ randomized designs, longer observational periods, and explore multiple metrics of cost-effectiveness.

Abstract

OBJECTIVES:
To report the results of health economic analyses comparing two treatment approaches for chronic low back pain (CLBP).
DESIGN:
Observational prospective cohort study comparing effectiveness and cost-effectiveness of CLBP care provided at an integrative care clinic with that provided in other clinics within the same hospital. CLBP-related medical utilization, function, quality of life, and days of work incapacity were self-reported at baseline, 3, 6, and 12 months.
SETTINGS/LOCATION:
Osher Clinical Center (OCC) based at a tertiary academic hospital (Brigham and Women's Hospital [BWH]) and other clinics at BWH.
SUBJECTS:
CLBP patients seeking care at OCC or non-OCC BWH clinics.
INTERVENTIONS:
Integrative or conventional care for CLBP as prescribed by the treating clinician(s).
OUTCOME MEASURES:
Quality-adjusted life years (QALYs) were estimated per treatment approach based on the SF-12. Cost per QALY gained was evaluated using an incremental cost-effectiveness ratio (ICER). ICERs based on CLBP-specific effectiveness measures (Roland Disability Questionnaire [RDQ] and bothersomeness of pain [BOP]) were exploratory outcomes.
RESULTS:
Total adjusted annual CLBP-related costs per patient were greater in the OCC versus non-OCC group ($11,526.73 vs. $6,810.63). Between group differences in QALYs were small and ICER estimate of cost per QALY gained was high ($436,676). However, unadjusted mean direct costs per patient decreased over time in the OCC group. Savings in direct costs of $391 (95% confidence interval: -1,078 to 1,861) were observed in the OCC group for the 6- to 12-month period, driven primarily by reduced medication usage. ICERs based on adjusted RDQ and BOP group differences showed cost of $2,073 and $4,203 for a one-point reduction per respective scale.
CONCLUSIONS:
When adjusted for baseline differences, self-reported costs were higher in the OCC group with only small effects on QALYs. However, trends toward decreased direct expenditures and medication usage over time warrant further investigation. Future studies evaluating potential benefits of integrative care models for the management of CLBP should employ randomized designs, longer observational periods, and explore multiple metrics of cost-effectiveness.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Institute of Complementary Medicine
Dewey Decimal Classification:610 Medicine & health
Uncontrolled Keywords:Complementary and alternative medicine
Language:English
Date:1 March 2019
Deposited On:23 Oct 2019 12:35
Last Modified:01 Nov 2019 13:44
Publisher:Mary Ann Liebert
ISSN:1075-5535
OA Status:Green
Free access at:PubMed ID. An embargo period may apply.
Publisher DOI:https://doi.org/10.1089/acm.2018.0503
PubMed ID:30870015

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