a Quantify Research , Stockholm , Sweden.
b LIME/MMC , Karolinska Institutet , Stockholm , Sweden.
J Med Econ. 2017 Dec;20(12):1281-1289. doi: 10.1080/13696998.2017.1372252. Epub 2017 Sep 11.
To develop a health economic model to evaluate the long-term costs and outcomes over the healthcare treatment pathway for patients with low back pain (LBP).
A health economic model, consisting of a decision tree structure with a Markov microsimulation model at the end of each branch, was created. Patients were followed from first observed clinical presentation with LBP until the age of 100 years or death. The underlying data to populate the model were based on Swedish national and regional registry data on healthcare resource use and sickness insurance in patients presenting with LBP in the Swedish region Västra Götaland during 2008-2012. Costs (outpatient healthcare visits, inpatient bed days, pharmaceuticals, productivity loss), EUR 2016, and quality-of-life based on EQ-5D data from the registries and published estimates were summarized over the lifetime of the patients with 3% annual discount. A lost quality-adjusted life year (QALY) was valued at €70,000.
Mean lifetime total cost was estimated at €47,452/patient, of which indirect costs were 57%. Total lifetime economic burden for all patients coming to clinical presentation in Sweden per year was €8.8bn. The average LBP patient was estimated to face a loss of 2.7 QALYs over their lifetime compared with the general population. For all patients in Sweden coming to clinical presentation in 1 year this gives 505,407 QALYs lost, valued at €35.3bn. Adding the economic burden, the total societal burden amounts to €44.1bn.
This pathway model shows that most patients with LBP receive conservative care, and a minority consume high-cost healthcare interventions like surgery. The model could be used to see broad economic effects of different patterns of healthcare provision in sub-groups with LBP and to estimate where it is possible to influence these pathways to increase utility for patients and for society.
开发一种健康经济学模型，以评估患有腰痛（LBP）的患者在整个医疗保健治疗路径中的长期成本和结果。
创建了一个健康经济学模型，该模型由决策树结构和每个分支末端的马尔可夫微模拟模型组成。患者从首次观察到腰痛的临床表现开始随访，直到 100 岁或死亡。用于填充模型的数据基于瑞典全国和地区登记数据，涉及 2008-2012 年在瑞典西约塔兰地区因腰痛就诊的患者的医疗资源使用和疾病保险情况。基于登记处的 EQ-5D 数据和已发表的估计值，汇总了患者一生中的成本（门诊医疗就诊次数、住院床日、药品、生产力损失），以 2016 年欧元计价，并使用质量调整生命年（QALY）进行了评估，贴现率为每年 3%。一个丧失的质量调整生命年（QALY）价值为 70,000 欧元。
估计每位患者的终生总成本为 47,452 欧元，其中间接成本占 57%。每年在瑞典就诊的所有腰痛患者的终生总经济负担为 88 亿欧元。估计平均腰痛患者在其一生中会损失 2.7 个 QALY，而普通人群则为 2.7 个 QALY。对于每年在瑞典就诊的所有患者，这意味着损失了 505,407 个 QALY，价值 353 亿欧元。加上经济负担，总社会负担达到 441 亿欧元。
该路径模型表明，大多数腰痛患者接受保守治疗，只有少数患者接受高成本的医疗保健干预措施，如手术。该模型可用于观察腰痛患者亚组中不同医疗服务提供模式的广泛经济影响，并估计在哪些方面可以影响这些路径，以提高患者和社会的效用。
