Analysis Group, Inc., New York, NY 10020, USA.
Spine J. 2011 Jul;11(7):622-32. doi: 10.1016/j.spinee.2011.03.017. Epub 2011 May 20.
Treatment guidelines suggest that most acute low back pain (LBP) episodes substantially improve within a few weeks and that immediate use of imaging and aggressive therapies should be avoided.
Assess the actual practice patterns of imaging, noninvasive therapy, medication use, and surgery in patients with LBP, and compare their costs to those of matched controls without LBP.
A retrospective analysis of claims data from 40 self-insured employers in the United States.
The study sample included 211,551 patients, aged 18 to 64 years, with one LBP diagnosis or more (per Healthcare Effectiveness Data and Information Set specification) during 2004 to 2006, identified from a claims database. Patients had continuous eligibility for 12 months or more after their index LBP diagnosis (study period), for 6 months or more before their index diagnosis (baseline period), and no other LBP diagnosis during the baseline period. Patients with LBP were matched to a random cohort of patients without LBP by age, gender, employment status, and index year.
Physiological measures (eg, imaging and diagnostic tests), functional measures (eg, pharmacologic and nonpharmacologic treatment for LBP, health-care resource use), and direct (medical and prescription drug) and indirect (disability and medically related absenteeism) costs were assessed within the year after the LBP diagnosis.
Univariate analyses described treatment patterns and compared baseline characteristics and study period costs.
Patients with LBP had significantly higher rates of baseline comorbidities and resource use compared with controls. Of patients with LBP, 41.6% had imaging mean (median) [standard deviation] 34.3 (0) [78.6] days after the LBP diagnosis. Most patients with LBP (69.4%) used medications starting 51.9 (8) [86.2] days after the diagnosis. Opioids were commonly prescribed early (41.6% of patients; after 82.8 (25) [105.9] days). Of patients with LBP, 2.05% had surgery during the study period. Patients with LBP were likely to have chiropractic treatment first, followed by pharmacotherapy with muscle relaxants and nonsteroidal anti-inflammatory drugs. Except for less surgery, these findings also held for patients with only nonspecific LBP. Patients with LBP had higher mean direct costs compared with controls ($7,211 vs. $2,382, respectively; p<.0001), with surgery patients having mean direct costs of $33,931.
Contrary to clinical guidelines, many patients with LBP start incurring significant resource use and associated expenses soon after the index diagnosis. Achieving guideline-concordant care will require substantial changes in LBP practice patterns.
治疗指南建议，大多数急性腰痛（LBP）发作在数周内会明显改善，应避免立即进行影像学检查和积极治疗。
评估 LBP 患者影像学检查、非侵入性治疗、药物使用和手术的实际治疗模式，并将其成本与无 LBP 的匹配对照组进行比较。
这是一项对美国 40 家自我保险雇主的索赔数据进行的回顾性分析。
研究样本包括 211551 名年龄在 18 至 64 岁之间的患者，他们在 2004 年至 2006 年间根据医疗保健效果数据和信息集规范至少有一次 LBP 诊断，从索赔数据库中确定。患者在其 LBP 指数诊断后的 12 个月或更长时间内（研究期间），在其指数诊断前 6 个月或更长时间内（基线期间）连续有资格获得治疗，且在基线期间没有其他 LBP 诊断。LBP 患者通过年龄、性别、就业状况和指数年份与随机无 LBP 患者队列相匹配。
生理指标（如影像学和诊断测试）、功能指标（如 LBP 的药物和非药物治疗、卫生保健资源利用）以及直接（医疗和处方药）和间接（残疾和与医疗相关的缺勤）成本在 LBP 诊断后一年内进行评估。
单变量分析描述了治疗模式，并比较了基线特征和研究期间的成本。
与对照组相比，LBP 患者的基线合并症和资源使用明显更高。在 LBP 患者中，41.6%的患者在 LBP 诊断后 34.3（0）[78.6]天进行影像学检查（平均值[中位数] [标准差]）。大多数 LBP 患者（69.4%）在诊断后 51.9（8）[86.2]天开始使用药物。阿片类药物早期常用（41.6%的患者；在 82.8（25）[105.9]天后）。在 LBP 患者中，2.05%在研究期间接受了手术。LBP 患者可能首先接受整脊治疗，然后接受肌肉松弛剂和非甾体抗炎药的药物治疗。除手术较少外，这些发现也适用于仅有非特异性 LBP 的患者。与对照组相比，LBP 患者的直接医疗费用平均高出 7211 美元，比对照组高出 2382 美元（分别为；p<.0001），手术患者的直接医疗费用平均为 33931 美元。
与临床指南相反，许多 LBP 患者在指数诊断后不久就开始产生大量的资源利用和相关费用。要实现符合指南的治疗，需要对 LBP 治疗模式进行重大改变。
