Chronic Lower Back Pain Management: A Cost Effectiveness Review
Lower back pain is one of the most prevalent musculoskeletal condition in the developed world and accounts for significant health services use. The American College of Physicians and the American Pain Society have published a joint clinical guideline that recommends providing patients with information on prognosis and self-management, use of medications with proven benefits and, for those who do not improve, consideration be given to the use of spinal manipulation (for acute lower back pain only), interdisciplinary rehabilitation, exercise, acupuncture, massage, yoga, cognitive behavioral therapy or relaxation.
The purpose of this review was to evaluate published economic evaluations of pharmacological management for chronic lower back pain.
A randomized controlled study was conducted in which total of seven studies were eligible for inclusion criteria. However, the quality of the economic evaluations undertaken in the included studies was not high. All studies provided reasonable information about what aspects of healthcare and other resource use were identified, measured and valued. The reporting of total costs was not uniform across the studies. Measures of pain and disability were the most commonly collected outcomes measures. In the conducted trial, two studies collected information on quality of life directly from participants while two studies modelled this information based on the literature.
Further economic evaluations of interventions for chronic low back pain should be based on the results of randomized controlled trial conducted. Measurement of costs and outcomes such as quality of life and quality adjusted life years should be included in the trial protocol. Included criteria should have sufficient follow up period which is sufficient to capture meaningful changes in both costs and outcomes, but in the absence of data of randomized controlled trial, economic models should be used to estimate future costs and outcomes using robust methods.