Background & Aims

Chronic primary low-back pain, formerly called, non-specific back pain, is one of the largest health burdens in countries around the globe. Pain specialists had developed a structured multimodal and interdisciplinary approach to its management in the 1980ies that leads to major improvements in functioning and quality of life and reduced work absenteeism. Such management is offered by specialized clinics in some countries, but is not generally available to the patient population at large. This is partly due to consideration that it may be too expensive. Led by the European Brain Council within the Value of Treatment (VoT) initiative, partners analysed to what extent the cost of structured interdisciplinary management is offset by savings in direct and indirect cost of current standard of care.
The aim of this study is to assess the cost-effectiveness of chronic pain management in Germany with and without structured interdisciplinary treatment in patients with chronic low back pain.

Methods

This cost-effectiveness analysis (CEA) is performed for a cohort of patients with initial acute pain episodes entering Step 3 of pain management of chronic low back pain. Data sources used include clinical trials, other published literature, and specific German epidemiology and costing data, and clinical expert opinion. The model includes relevant economic measures such as resource utilization patterns associated with outpatient and inpatient care for the treatment of chronic low back pain. This analysis is conducted according to the country-specific guidelines for economic evaluations and budget impact analyses. This CEA is based on a 5-year time horizon with discount rate of 3% for clinical and economic outcomes.
A Markov model is constructed for chronic pain management in Germany for non-specific chronic low back pain. The Markov health states are corresponding with Steps 3 to 5 in a pain management flowchart including an absorption state for refractory patients.

Results

Using Germany as a model country, standard of care was estimated to yield 3.46 QALYs over 5 years at a cost of € 5,178 per patient. Structured interdisciplinary management was estimated to yield 3.71 QALYs at € 4,998 cost in patients with chronic low back pain. Thus a broader availability of structured interdisciplinary management and self-management is predicted to yield an improvement by 0.25 QALY with a saving of €180 per patient. Extensive sensitivity analyses and scenario analyses confirmed that the base case cost-effectiveness estimate was robust. One-way sensitivity analyses showed that the model was most sensitive to proportion of patients switching to structured interdisciplinary management.

Conclusions

In terms of health economic modelling, pain management with structured interdisciplinary approach based on a shared bio-psycho-social model can be called a “dominant strategy” compared to standard pain management as it leads to both cost savings and QALY gain. Therefore, the inclusion of structured interdisciplinary treatment is cost-effective for German society. Hence, European guidelines should recommend the this approach as first line treatment for chronic low-back pain, for the benefit of both the people affected and the German economy at large.

References

Wenig CM, Schmidt CO, Kohlmann T, Schweikert B. Costs of back pain in Germany. Eur J Pain. 2009 Mar;13(3):280-6. doi: 10.1016/j.ejpain.2008.04.005. Epub 2008 Jun 3. PMID: 18524652.Liedgens H, Obradovic M, De Courcy J, Holbrook T, Jakubanis R. A burden of illness study for neuropathic pain in Europe. Clinicoecon Outcomes Res. 2016 Apr 27;8:113-26. doi: 10.2147/CEOR.S81396. PMID: 27217785; PMCID: PMC4853004.

Bundesärztekammer (BÄK), Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) (2017). Nationale VersorgungsLeitlinie Nicht-spezifischer Kreuz-schmerz – Langfassung, 2. Auflage. Version 1. 2017 [cited: jjjj mmm tt]. DOI: 10.6101/AZQ/000353. www.kreuzschmerz.versorgungsleitlinien.de

Presenting Author

Mark Nuijten

Poster Authors

mark nuijten

MD, PhD.

a2m

Lead Author

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Ulrike KAISER

PhD Dr

University Hospital Schleswig-Holstein, Clinic for Anesthesiology / Intensive Care Medicine, Lübeck

Lead Author

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Geert dom prof. dr.

Antwerp University, Belgium

Lead Author

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elena ENAX-KRUMOVA

Prof Dr,

University Hospital Bergmannsheil Bochum, Germany

Lead Author

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Dieyenaba FAYE

European Brain Council

Lead Author

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Winfried HÄUSER

Prof. Dr.

Psychosomatic Medicine and Psychotherapy, Technical University of Munich

Lead Author

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Levent Ertu?rul INAN

Prof. Dr

Health Sciences University, Ankara SUAM, Turkey

Lead Author

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Serge PERROT

MD

Centre de la Douleur, Hôpital Cochin, Université de Paris

Lead Author

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Gudula PETERSEN

Dr

Grunenthal, Germany

Lead Author

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Frank PETZKE

Prof. Dr

Department of Anesthesiology, University Hospital Medical Center, Gottingen, Germany

Lead Author

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Martin RAKUSA

Prof. Dr.

University Medical Center Maribor, Slovenia

Lead Author

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Deirdre RYAN

Pain Alliance Europe

Lead Author

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Rolf-Detlef Treede

Heidelberg University

Lead Author

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Topics

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