• Afschin Gandjour, Axel Telzerow, Karl W Lauterbach, and INTERCARE International Investigators.
• Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany. afschin.gandjour@medizin.uni-koeln.de
• Spine. 2005 Apr 15;30(8):969-75.

Study DesignRetrospective multicenter observational study.ObjectivesTo compare the outpatient quality and costs of treating acute back pain in England, Germany, the Netherlands, and Switzerland.Summary Of Background DataNo study has yet attempted to compare the quality, costs, and resource utilization of acute back pain treatment in Europe.MethodsA total of 130 randomly selected physician practices assessed services for 1 hypothetical average patient during the first 4 weeks of treatment (cost evaluation) and 127 practices reported retrospective data on 1 real patient (quality evaluation) in 2001. Reimbursement fees served as unit costs for Germany and Switzerland. Average reimbursement fees were used to measure resource utilization in all countries. Quality of care was assessed in terms of the following unnecessary treatments and diagnoses: bed rest for more than 2 days; exercise therapy; scheduling of a radiograph or other imaging tests; and referral to another provider. Responses were weighted with the level of scientific evidence for overuse.ResultsWeighted-average overuse ranged from 18% in the Netherlands to 31% in Germany. In England, Germany, and Switzerland, at least a third of the resources used to treat back pain were wasted.ConclusionsThere was considerable waste in treating acute back pain. The Netherlands had highest quality and lowest resource utilization in providing treatment for acute back pain.

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