European Spine Journal

, Volume 27, Issue 1, pp 109–116 | Cite as

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

  • Chung-Wei Christine LinEmail author
  • Qiang Li
  • Christopher M. Williams
  • Christopher G. Maher
  • Richard O. Day
  • Mark J. Hancock
  • Jane Latimer
  • Andrew J. Mclachlan
  • Stephen Jan
Original Article



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.


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.


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.


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.


Low back pain Costs and cost analysis Health care costs Paracetamol 



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.

Compliance with ethical standards

Conflict of interest



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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Chung-Wei Christine Lin
    • 1
    Email author
  • Qiang Li
    • 1
  • Christopher M. Williams
    • 2
  • Christopher G. Maher
    • 1
  • Richard O. Day
    • 3
  • Mark J. Hancock
    • 4
  • Jane Latimer
    • 1
  • Andrew J. Mclachlan
    • 5
  • Stephen Jan
    • 1
  1. 1.The George Institute for Global Health, Sydney Medical SchoolThe University of SydneySydneyAustralia
  2. 2.Hunter Medical Research Institute, School of Medicine and Public HealthUniversity of NewcastleNewcastleAustralia
  3. 3.St Vincent’s Hospital Clinical School and Pharmacology, School of Medical Sciences, Faculty of MedicineUniversity of New South WalesSydneyAustralia
  4. 4.Faculty of Medicine and Health SciencesMacquarie UniversitySydneyAustralia
  5. 5.Faculty of Pharmacy and Centre for Education and Research on AgeingThe University of SydneySydneyAustralia

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