THE COST-EFFECTIVENESS OF A TREATMENT-BASED CLASSIFICATION (TBC) APPROACH COMPARED TO A USUAL CARE APPROACH IN THE MANAGEMENT OF LOW-BACK PAIN IN THE OUTPATIENT PHYSICAL THERAPY SETTING

摘要

Purpose and Study Design: Retrospective cohort cost-minimization analysis (payer perspective) with decision analysis model to access cost-effectiveness of a treatment-based algorithm (TBC) for low back pain (LBP) compared to a "usual" care strategy in the outpatient setting.Methods: charge data was examined on 750 subjects with LBP from 42 regional clinics over 1 year period. Subjects were determined to be on or off protocol for the classification algorithms based on provider responses to minimum required initial exam and history intake data and subsequent interventions provided. Primary outcome measures were total net direct health care and physical therapy costs, along with total member and physical therapy member burden costs. In addition, protocol status was examined as a predictor variable for the following: top quartile of total direct health care and physical therapy expenditures, as well as total direct health care and physical therapy member burden. A 4% / yearly discounting rate was applied.Results: Baseline characteristics of the combined sample demonstrated a significant proportion of Medical Assistance patients were given non-adherent care. In addition, a significant but not clinical difference was found in fear-avoidance behavioral questionnaire physical activity (FABQ_PA) scores. Incremental cost-savings were demonstrated in all primary outcome measures for the combined sample. The specific exercise and flexion off-protocol subgroups demonstrated member burden savings but this was explained exclusively after adjustment by having Medical Assistance as an insurance type. Off-protocol status accounted for significant variation in explaining differences in the statistically different outcomes, as well as demonstrating predictive ability for attaining the top quartile of total direct health care expenditures. The decision analysis model demonstrated the dominance of classification approach to usual care across a variety of associated variable ranges and distributions.Conclusions: This evidence supports the TBC as a cost-effective alternative for LBP treatment compared to usual physical therapy care. It appears beneficial for a payer to adopt strategies to improve compliance with the TBC. Further recommendations are suggested to either validate or cross-validate these findings and to improve outcomes reporting. The TBC should also be compared as a cost-effective alternative to treating LBP against primary-care (non-rehabilitative) and chiropractic.