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基于分类系统的亚急性和慢性下背痛的成本效益分析。

Cost-effectiveness of a classification-based system for sub-acute and chronic low back pain.

机构信息

Department of Epidemiology and Biostatistics and the EMGO+ Institute for Health and Care Research, VU University Medical Centre, Van der Boechorststraat 7, Amsterdam 1081 BT, The Netherlands.

出版信息

Eur Spine J. 2012 Jul;21(7):1290-300. doi: 10.1007/s00586-011-2144-4. Epub 2012 Jan 19.

DOI:10.1007/s00586-011-2144-4
PMID:22258622
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3389120/
Abstract

PURPOSE

Identifying relevant subgroups in patients with low back pain (LBP) is considered important to guide physical therapy practice and to improve outcomes. The aim of the present study was to assess the cost-effectiveness of a modified version of Delitto's classification-based treatment approach compared with usual physical therapy care in patients with sub-acute and chronic LBP with 1 year follow-up.

METHODS

All patients were classified using the modified version of Delitto's classification-based system and then randomly assigned to receive either classification-based treatment or usual physical therapy care. The main clinical outcomes measured were; global perceived effect, intensity of pain, functional disability and quality of life. Costs were measured from a societal perspective. Multiple imputations were used for missing data. Uncertainty surrounding cost differences and incremental cost-effectiveness ratios was estimated using bootstrapping. Cost-effectiveness planes and cost-effectiveness acceptability curves were estimated.

RESULTS

In total, 156 patients were included. The outcome analyses showed a significantly better outcome on global perceived effect favoring the classification-based approach, and no differences between the groups on pain, disability and quality-adjusted life-years. Mean total societal costs for the classification-based group were 2,287, and for the usual physical therapy care group 2,020. The difference was 266 (95% CI -720 to 1,612) and not statistically significant. Cost-effectiveness analyses showed that the classification-based approach was not cost-effective in comparison with usual physical therapy care for any clinical outcome measure.

CONCLUSION

The classification-based treatment approach as used in this study was not cost-effective in comparison with usual physical therapy care in a population of patients with sub-acute and chronic LBP.

摘要

目的

在腰痛（LBP）患者中识别相关亚组被认为对于指导物理治疗实践和改善结局很重要。本研究的目的是评估改良版 Delitto 分类治疗方法与亚急性和慢性 LBP 患者 1 年随访期间的常规物理治疗护理相比的成本效益。

方法

所有患者均使用改良版 Delitto 分类系统进行分类，然后随机分为接受分类治疗或常规物理治疗护理。主要临床结局指标包括：整体感知效果、疼痛强度、功能障碍和生活质量。从社会角度测量成本。使用多重插补处理缺失数据。使用自举法估计成本差异和增量成本效益比的不确定性。绘制成本效益平面和成本效益接受曲线。

结果

共纳入 156 例患者。结果分析显示，分类治疗方法在整体感知效果方面有显著改善，而在疼痛、残疾和质量调整生命年方面两组间无差异。分类组的总社会成本平均为2287，常规物理治疗护理组为2020。两组间差异为266（95%CI-720 至1612），无统计学意义。成本效益分析显示，与常规物理治疗护理相比，分类治疗方法在任何临床结局指标方面均不具有成本效益。

结论

与常规物理治疗护理相比，本研究中使用的基于分类的治疗方法在亚急性和慢性 LBP 患者人群中不具有成本效益。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9bfb/3389120/592bf371f0ca/586_2011_2144_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9bfb/3389120/cc11ec243be7/586_2011_2144_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9bfb/3389120/fdfdde814f36/586_2011_2144_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9bfb/3389120/592bf371f0ca/586_2011_2144_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9bfb/3389120/cc11ec243be7/586_2011_2144_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9bfb/3389120/fdfdde814f36/586_2011_2144_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9bfb/3389120/592bf371f0ca/586_2011_2144_Fig3_HTML.jpg

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