Maetzel Andreas, Li Linda
Arthritis and Autoimmunity Research Centre, Consultation and Rehabilitation Service, University Health Network, The Arthritis Society (Ontario Division), Toronto, Canada.
Best Pract Res Clin Rheumatol. 2002 Jan;16(1):23-30. doi: 10.1053/berh.2001.0204.
Low back pain (LBP) poses an economic burden to society, mainly in terms of the large number of work days lost by a small percentage of patients who develop chronic LBP. The object of this review is to gain a better understanding of the societal costs of LBP and to see whether current clinical management follows evidence-based guidelines and is economically attractive, by reviewing studies on LBP with economic implications. To this end, the Medline database was searched between 1996 and 2001 using appropriate keywords, broadly defined. A total of 372 abstracts were screened and paper copies of 73 potentially relevant articles were obtained. It was found that the cost of LBP illness was high and was comparable to other disorders such as headache, heart disease, depression or diabetes, but actual cost estimates varied depending on the costing methodology employed. A small percentage of patients with chronic LBP accounts for a large fraction of the costs. Excessive and inappropriate use of diagnostic or therapeutic services can be documented but varied by region and provider type. Management according to evidence-based guidelines was not necessarily economically attractive. Interventions for acute or chronic LBP failed to show economic benefits, but demonstrated modest clinical benefits, which suggested a weak relationship between clinical and economic outcomes. The conclusion was that common definitions and costing methodologies need to be found to gain a better understanding of the true costs to society and to make studies comparable. A better definition is needed for the type for patient with LBP for whom therapeutic management is most likely to have a long-lasting economic benefit.
腰痛给社会带来了经济负担，主要体现在一小部分发展为慢性腰痛的患者损失了大量工作日。本综述的目的是通过回顾具有经济影响的腰痛研究，更好地了解腰痛的社会成本，并查看当前的临床管理是否遵循循证指南以及在经济上是否具有吸引力。为此，在1996年至2001年期间使用广义定义的适当关键词对Medline数据库进行了检索。共筛选了372篇摘要，并获取了73篇可能相关文章的纸质副本。结果发现，腰痛疾病的成本很高，与头痛、心脏病、抑郁症或糖尿病等其他疾病相当，但实际成本估计因所采用的成本核算方法而异。一小部分慢性腰痛患者占了成本的很大一部分。可以证明存在诊断或治疗服务的过度和不当使用情况，但因地区和提供者类型而异。根据循证指南进行管理在经济上不一定具有吸引力。对急性或慢性腰痛的干预未能显示出经济效益，但显示出适度的临床效益，这表明临床和经济结果之间的关系较弱。结论是，需要找到通用的定义和成本核算方法，以更好地了解对社会的真实成本并使研究具有可比性。对于治疗管理最有可能产生长期经济效益的腰痛患者类型，需要有更好的定义。
