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The economic burden of guideline-recommended first line care for acute low back pain

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Abstract

Purpose

To report health care costs and the factors associated with such costs in people with acute low back pain receiving guideline-recommended first line care.

Methods

This is a secondary analysis of a trial which found no difference in clinical outcomes. Participants with acute low back pain received reassurance and advice, and either paracetamol (taken regularly or as needed) or placebo for up to 4 weeks and followed up for 12 weeks. Data on health service utilisation were collected by self-report. A health sector perspective was adopted to report all direct costs incurred (in 2015 AUD, 1 AUD = 0.53 Euro). Costs were reported for the entire study cohort and for each group. Various baseline clinical, demographic, work-related and socioeconomic factors were investigated for their association with increased costs using generalised linear models.

Results

The mean cost per participant was AUD167.74 (SD = 427.24) for the entire cohort (n = 1365). Most of these costs were incurred in primary care through visits to a general practitioner or physiotherapist. Compared to the placebo group, there was an increase in cost when paracetamol was taken. Multivariate analysis showed that disability, symptom duration and compensation were associated with costs. Receiving compensation was associated with a twofold increase compared to not receiving compensation.

Conclusions

Taking paracetamol as part of first line care for acute low back pain increased the economic burden. Higher disability, longer symptom duration and receiving compensation were independently associated with increased health care costs.

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Acknowledgments

Data for this study originated from a clinical trial funded by the National Health and Medical Research Council (NHMRC) of Australia. GlaxoSmithKline Australia provided subsequent supplementary funding and the paracetamol and matched placebo. CL, CW, CM and SJ receive research fellowships from NHMRC. JL received funding from an ARC Future Fellowship. AM is the Program Director of the NHMRC Centre for Research Excellence in Medicines and Ageing.

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Authors and Affiliations

  1. The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia

    Chung-Wei Christine Lin, Qiang Li, Christopher G. Maher, Jane Latimer & Stephen Jan

  2. Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia

    Christopher M. Williams

  3. St Vincent’s Hospital Clinical School and Pharmacology, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia

    Richard O. Day

  4. Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia

    Mark J. Hancock

  5. Faculty of Pharmacy and Centre for Education and Research on Ageing, The University of Sydney, Sydney, NSW, Australia

    Andrew J. Mclachlan

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  1. Chung-Wei Christine Lin
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  2. Qiang Li
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  3. Christopher M. Williams
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  4. Christopher G. Maher
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Correspondence to Chung-Wei Christine Lin.

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Lin, CW.C., Li, Q., Williams, C.M. et al. The economic burden of guideline-recommended first line care for acute low back pain. Eur Spine J 27, 109–116 (2018). https://doi.org/10.1007/s00586-016-4781-0

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  • DOI: https://doi.org/10.1007/s00586-016-4781-0

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