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Is an enhanced behaviour change intervention cost-effective compared with physiotherapy for patients with chronic low back pain? Results from a multicentre trial in Israel

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Canaway, Alastair, Pincus, Tamar, Underwood, Martin, Shapiro, Yair, Chodick, Gabriel and Ben-Ami, Noa (2018) Is an enhanced behaviour change intervention cost-effective compared with physiotherapy for patients with chronic low back pain? Results from a multicentre trial in Israel. BMJ Open, 8 (4). e019928. doi:10.1136/bmjopen-2017-019928

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Official URL: https://doi.org/10.1136/bmjopen-2017-019928

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Abstract

Objective: To assess the cost-effectiveness of an enhanced transtheoretical model of behaviour change in conjunction with physiotherapy compared with standard care (physiotherapy) in patients with chronic lower back pain (CLBP).

Design: Cost-utility and cost-effectiveness analyses alongside a multicentre controlled trial from a healthcare perspective with a 1-year time horizon.

Setting: The trial was conducted in eight centres within the Sharon district in Israel.

Participants: 220 participants aged between 25 and 55 years who suffered from CLBP for a minimum of 3 months were recruited.

Interventions: The intervention used a model of behaviour change that sought to increase the adherence and implementation of physical activity in conjunction with physiotherapy. The control arm received standard care in the form of physiotherapy.

Primary and secondary measures: The primary outcome was the incremental cost per quality-adjusted life year (QALY) of the intervention arm compared with standard care. The secondary outcome was the incremental cost per Roland-Morris Disability Questionnaire point.

Results: The cost per QALY point estimate was 10 645 New Israeli shekels (NIS) (£1737.11). There was an 88% chance the intervention was cost-effective at NIS50 000 per QALY threshold. Excluding training costs, the intervention dominated the control arm, resulting in fewer physiotherapy and physician visits while improving outcomes.

Conclusions: The enhanced transtheoretical model intervention appears to be a very cost-effective intervention leading to improved outcomes for low cost. Given limitations within this study, there is justification for examining the intervention within a larger, long-term randomised controlled trial.

Item Type: Journal Article
Subjects: R Medicine > RC Internal medicine
Divisions: Faculty of Medicine > Warwick Medical School > Health Sciences > Clinical Trials Unit
Faculty of Medicine > Warwick Medical School > Health Sciences
Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Backache -- Treatment -- Israel, Exercise -- Health aspects, Behavior modification -- Research, Backache -- Treatment -- Cost effectiveness, Quality of life
Journal or Publication Title: BMJ Open
Publisher: BMJ
ISSN: 2044-6055
Official Date: 10 April 2018
Dates:
DateEvent
10 April 2018Published
25 January 2018Accepted
Volume: 8
Number: 4
Article Number: e019928
DOI: 10.1136/bmjopen-2017-019928
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Open Access
RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
UNSPECIFIEDMaccabbi Healthcare Serviceshttp://dx.doi.org/10.13039/501100006297

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