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Interdisziplinäre, multimodale Schmerztherapie vs. konventionelle Therapie

Eine Kostenanalyse bei Patienten mit chronischen Rückenschmerzen

Multidisciplinary outpatient care program vs. usual care

Cost-benefit analysis in patients with chronic low back pain

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Zusammenfassung

Hintergrund

In westlichen Industrienationen stellen chronische Rückenschmerzen eine große medizinische Herausforderung dar, die mit erheblichen Kosten verbunden ist. Die Kosten teilen sich auf in direkte Kosten, die im Zusammenhang mit der eigentlichen Leistungserstellung stehen, und indirekte Kosten, die durch Arbeitsunfähigkeit verursacht werden. Trotz vorhandener Evidenz ist der ökonomische Nutzen der interdisziplinären, multimodalen Schmerztherapie (IMS) zur Behandlung von Patienten mit chronischen Rückenschmerzen bisher noch nicht vollständig untersucht.

Zielsetzung

Durchführung einer Kostenanalyse der IMS im Vergleich zur konventionellen konservativen Schmerztherapie bei Patienten mit chronischen Rückenschmerzen.

Material and Methoden

In die Studie konnten 514 Patienten mit chronischen Rückenschmerzen eingeschlossen werden. Dazu wurden zwei Behandlungskonzepte miteinander verglichen: zum einen eine IMS, die Patientenschulung, körperliche Aktivität, Verhaltenstherapie, Entspannung und Alltagstraining beinhaltet, zum anderen eine normale nichtoperative konventionelle Schmerztherapie durch Ärzte und Gesundheitsfachkräfte. An der IMS nahmen 257 Patienten teil; die anderen 257 Patienten erhielten eine normale Standardversorgung.

Ergebnisse

Die Gesamtkosten pro Patient betrugen nach einem Jahr in der Gruppe mit der IMS 10.584,14 ± 9.730,87 €. Diese Summe liegt um 3.161,63 € (2.845,30–3.477,96 €) signifikant unterhalb der Gesamtkosten der Kontrollgruppe, welche die Regelversorgung erhielt. Die direkten Kosten sind relativ gering (6–12 %), während die indirekten Kosten einen deutlich höheren Anteil ausmachen (80–93 %).

Schlussfolgerung

Die Ergebnisse können zu einer besseren Ressourcenallokation bei Patienten mit chronischen Rückenschmerzen führen. IMS-Programme ermöglichen eine schnelle Rückkehr an den Arbeitsplatz.

Abstract

Background

Chronic low back pain (CLBP) is a major health problem in industrialized nations and is associated with very high total costs. These costs are split between direct costs brought about by the utilization of health care services and indirect costs due to back pain-related loss of productivity. Despite the existence of some evidence about the effectiveness of a multidisciplinary outpatient care programmes in Germany, the economic benefit of these programmes has not yet been studied in detail.

Objective

To provide an economic evaluation of the cost benefits of a multidisciplinary outpatient care programme for patients with chronic low back pain (CLBP) compared to those undergoing conventional care.

Materials and methods

An economic evaluation was performed in 514 patients who have been diagnosed with LBP. Two interventions will be compared: (1) a multidisciplinary outpatient care programme consisting of education, activity programmes, cognitive behavioural therapy, work hardening and functional restoration and (2) the usual noninvasive care provided by medical specialists and health care professionals. In all, 257 patients were involved in a 4 week multidisciplinary outpatient care programme, while the other 257 were subject to conventional care.

Results

The total costs per patient were estimated to be € 10,584.14 ( ± € 9,730.87) after 1 year in the group with the multidisciplinary care programme. The results show a significant reduction in the total amount of costs € 3,161.63 (range € 2,845.30–3,477.96) compared to the usual care group. However, the direct costs are minor (6–12 %) compared to the indirect costs (80–93 %).

Conclusion

This study provides important information which is of value for decision-making and making an adequate allocation of medical resources for patients with CLBP. A multidisciplinary outpatient care programme can facilitate rapid return to work.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. U. Marnitz ist Geschäftsführer des Rückenzentrums am Markgrafenpark GmbH. J. Brömme, M. Mohokum und A.C. Disch geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Park-Klinik Weissensee, Schönstr. 80, 13086, Berlin, Deutschland

    J. Brömme

  2. SRH Fachhochschule für Gesundheit Gera GmbH, Gera, Deutschland

    M. Mohokum

  3. Centrum für Muskuloskeletale Chirurgie, Klinik für Orthopädie und Unfallchirurgie, Charité Universitätsmedizin Berlin, Berlin, Deutschland

    A.C. Disch

  4. Rückenzentrum am Markgrafenpark GmbH, Berlin, Deutschland

    U. Marnitz

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  1. J. Brömme
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  2. M. Mohokum
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  4. U. Marnitz
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Correspondence to J. Brömme.

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Brömme, J., Mohokum, M., Disch, A. et al. Interdisziplinäre, multimodale Schmerztherapie vs. konventionelle Therapie. Schmerz 29, 195–202 (2015). https://doi.org/10.1007/s00482-014-1508-1

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  • DOI: https://doi.org/10.1007/s00482-014-1508-1

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