Department of Epidemiology and Community Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5 Canada.
Spine J. 2009 Nov;9(11):944-57. doi: 10.1016/j.spinee.2009.07.007. Epub 2009 Sep 12.
Low back pain (LBP) is associated with high health-care utilization and lost productivity. Numerous interventions are routinely used, although few are supported by strong evidence. Cost utility analyses (CUAs) may be helpful to inform decision makers.
To conduct a systematic review of CUAs of interventions for LBP.
Systematic review.
A search strategy combining medical subject headings and free text related to LBP and health economic evaluations was executed in MEDLINE. Cost utility analyses combined with randomized controlled trials for LBP were included. Studies that were published before 1998, non-English, decision analyses, and duplicate reports were excluded. Search results were evaluated by two reviewers, who extracted data independently related to clinical study design, economic study design, direct cost components, utility results, cost results, and CUA results.
The search produced 319 citations, and of these 15 met eligibility criteria. Most were from the United Kingdom (n=8), published in the past 3 years (n=12), studied chronic LBP or radiculopathy (n=13), and had a follow-up >12 months (n=13). Combined, there were 33 study groups who received a mean 2.1 interventions, most commonly education (n=17), exercise therapy (n=13), spinal manipulation therapy (n=7), surgery (n=7), and usual care from a general practitioner (n=7). Mean baseline utility was 0.57, improving to 0.67 at follow-up; the mean difference in utility improvement between study groups was 0.04. Based on available data and converted to US dollars, the cost per quality-adjusted life year ranged from $304 to 579,527 dollars, with a median of 13,015 dollars.
Few CUAs were identified for LBP, and there was heterogeneity in the interventions compared, direct cost components measured, indirect costs, other methods, and results. Reporting quality was mixed. Currently published CUAs do not provide sufficient information to assist decision makers. Future CUAs should attempt to measure all known direct cost components relevant to LBP, estimate indirect costs such as lost productivity, have a follow-up period sufficient to capture meaningful changes, and clearly report methods and results to facilitate interpretation and comparison.
下腰痛（LBP）与高医疗保健利用率和生产力损失有关。尽管有许多干预措施得到常规应用，但其中很少有强有力的证据支持。成本效用分析（CUA）可能有助于为决策者提供信息。
对 LBP 干预措施的成本效用分析进行系统评价。
系统评价。
在 MEDLINE 中执行了一项结合了与 LBP 和健康经济评估相关的医学主题词和自由文本的搜索策略。纳入了与 LBP 相关的随机对照试验的成本效用分析。排除了 1998 年以前发表的、非英语的、决策分析和重复报告的研究。由两名评审员独立评估检索结果，他们分别提取与临床研究设计、经济研究设计、直接成本组成部分、效用结果、成本结果和 CUA 结果相关的数据。
搜索结果产生了 319 条引文，其中 15 条符合入选标准。大多数来自英国（n=8），发表于过去 3 年（n=12），研究慢性 LBP 或神经根病（n=13），随访时间>12 个月（n=13）。共有 33 个研究组接受了平均 2.1 种干预措施，最常见的是教育（n=17）、运动疗法（n=13）、脊柱手法治疗（n=7）、手术（n=7）和全科医生的常规治疗（n=7）。平均基线效用为 0.57，随访时提高到 0.67；研究组之间的效用改善差异平均为 0.04。根据现有数据并转换为美元，每质量调整生命年的成本范围为 304 至 579,527 美元，中位数为 13,015 美元。
针对 LBP 的 CUA 很少，与所比较的干预措施、测量的直接成本组成部分、间接成本、其他方法和结果相比，存在异质性。报告质量参差不齐。目前发表的 CUA 没有提供足够的信息来帮助决策者。未来的 CUA 应尝试测量与 LBP 相关的所有已知直接成本组成部分，估计间接成本（如生产力损失），随访时间足以捕捉有意义的变化，并清楚地报告方法和结果，以方便解释和比较。
