• Daniel I Rhon, Minchul Kim, Carl Asche, and Steven Z George.
• Department of Rehabilitation Medicine, Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX.
• Spine. 2024 Sep 6.

Study DesignCost-effectiveness of two trial interventions for low back pain.ObjectiveTo investigate the incremental cost-effectiveness between risk-stratified and usual care for low back pain.Summary Of Background DataA recent trial compared risk-stratified care to usual care for patients with low back pain (LBP) in the US Military Health System. While the outcomes were no different between groups, risk-stratified care is purported to use fewer resources and therefore could be a more cost-effective intervention. Risk-stratified care matches treatment based on low, medium, or high risk for poor prognosis.MethodsThe cost-effectiveness of usual care versus risk-stratified care for low back pain was assessed, using the healthcare perspective. Patients were recruited from primary care. The main outcome was indicating incremental cost-effectiveness between two alternative treatments. Acceptability curves of bootstrapped incremental cost effectiveness ratios (ICER) were used to identify the proportion of ICERs under the specific willingness-to-pay (WTP) level ($50,000 to $100,000). Health system costs (total and back-related) and health-related quality-of-life (HRQoL) based on quality-adjusted-life-years (QALYs) were obtained.Results271 participants (33.6% female), mean age 34.3 +/-8.7 were randomized 1:1 and followed for 1 year. Mean back-related medical costs were not significantly different (mean difference $5; 95CI -$398, $407; P=0.982), nor were total medical costs (mean difference $827, 95CI -$1748, $3403; P=0.529). The mean difference in QALYs was not significantly different between groups (0.009; 95CI -0.014, 0.032; P=0.459). The incremental net monetary benefit (NMB) at the willingness to pay (WTP) threshold of $100,000 was $792 for back-related costs, with the lower bound confidence interval negative at all WTP levels.ConclusionRisk-stratified care was not cost-effective for medium- and low-risk individuals compared to usual care. Further research is needed to assess whether there is value for high-risk individuals or for other risk-stratification approaches.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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