• Larkin L Strong, Michael Von Korff, Kathleen Saunders, and James E Moore.
• Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, WA, USA. Lstrong@u.washington.edu
• Spine. 2006 Jul 1;31(15):1639-45.

Study DesignTwo randomized, controlled trials.ObjectiveTo evaluate the incremental cost-effectiveness of psychologist-led and lay-led interventions in reducing disability in 2 cohorts of primary care patients with back pain.Summary Of Background DataAlthough activating self-care interventions have been advanced as effective tools to reduce back pain-related activity limitations, few studies have evaluated the added costs of these programs relative to their added benefits.MethodsWe estimated the incremental benefits and incremental costs associated with 2 self-care interventions for primary care patients with back pain. Effectiveness was measured as the number of low-impact back pain days (i.e., days when patients were satisfied with their level of back pain) over a 1-year follow-up. Costs of back-pain related services were estimated from health plan cost data. Incremental cost-effectiveness ratios were calculated for each intervention to determine the costs associated with an additional low-impact back pain day.ResultsPatients assigned to the lay and psychologist interventions had a mean of 14.3 (95% confidence interval [CI] -2.7 to 30.9) and 26.2 (95% CI 9.1-44.4) additional low-impact back pain days, respectively, compared with patients receiving usual care. The incremental per-person costs of the lay-led and psychologist-led interventions were dollar 139 (95% CI - dollar 62.13 to dollar 321.76) and dollar 161 (95% CI dollar 51.18 to dollar 275.93), respectively. The mean cost of an additional low-impact back pain day was dollar 9.70 for the lay-led intervention and dollar 6.13 for the psychologist-led intervention.ConclusionsBoth the lay and psychologist interventions were associated with modest improvements in outcomes but with somewhat higher costs compared to usual care.

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