Economic evaluation of a healthy lifestyle intervention for chronic low back pain: A randomized controlled trial

Amanda Williams; Johanna M van Dongen; Steven J Kamper; Kate M O'Brien; Luke Wolfenden; Sze L Yoong; Rebecca K Hodder; Hopin Lee; Emma K Robson; Robin Haskins; Chris Rissel; John Wiggers; Christopher M Williams

doi:10.1002/ejp.1334

Economic evaluation of a healthy lifestyle intervention for chronic low back pain: A randomized controlled trial

Amanda Williams, Johanna M van Dongen, Steven J Kamper, Kate M O'Brien, Luke Wolfenden, Sze L Yoong, Rebecca K Hodder, Hopin Lee, Emma K Robson, Robin Haskins, Chris Rissel, John Wiggers, Christopher M Williams

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Abstract

BACKGROUND: Economic evaluations which estimate cost-effectiveness of potential treatments can guide decisions about real-world healthcare services. We performed an economic evaluation of a healthy lifestyle intervention targeting weight loss, physical activity and diet for patients with chronic low back pain, who are overweight or obese.

METHODS: Eligible patients with chronic low back pain (n = 160) were randomized to an intervention or usual care control group. The intervention included brief advice, a clinical consultation and referral to a 6-month telephone-based healthy lifestyle coaching service. The primary outcome was quality-adjusted life years (QALYs). Secondary outcomes were pain intensity, disability, weight and body mass index. Costs included intervention costs, healthcare utilization costs and work absenteeism costs. An economic analysis was performed from the societal perspective.

RESULTS: Mean total costs were lower in the intervention group than the control group (-$614; 95%CI: -3133 to 255). The intervention group had significantly lower healthcare costs (-$292; 95%CI: -872 to -33), medication costs (-$30; 95%CI: -65 to -4) and absenteeism costs (-$1,000; 95%CI: -3573 to -210). For all outcomes, the intervention was on average less expensive and more effective than usual care, and the probability of the intervention being cost-effective compared to usual care was relatively high (i.e., 0.81) at a willingness-to-pay of $0/unit of effect. However, the probability of cost-effectiveness was not as favourable among sensitivity analyses.

CONCLUSIONS: The healthy lifestyle intervention seems to be cost-effective from the societal perspective. However, variability in the sensitivity analyses indicates caution is needed when interpreting these findings.

SIGNIFICANCE: This is an economic evaluation of a randomized controlled trial of a healthy lifestyle intervention for chronic low back pain. The findings suggest that a healthy lifestyle intervention may be cost-effective relative to usual care.

Original language	English
Pages (from-to)	621-634
Number of pages	14
Journal	European Journal of Pain
Volume	23
Issue number	3
Early online date	31 Oct 2018
DOIs	https://doi.org/10.1002/ejp.1334
Publication status	Published - Mar 2019

Funding

This study was funded by Hunter New England Local Health District, the University of Newcastle and the Hunter Medical Research Institute. The institutions had no involvement in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Funders	Funder number
Hunter New England Local Health District
Newcastle University
Hunter Medical Research Institute

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Economic evaluation of a healthy lifestyle intervention for chronic low back painFinal published version, 914 KBLicence: Article 25fa Dutch Copyright Act

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Williams, A., van Dongen, J. M., Kamper, S. J., O'Brien, K. M., Wolfenden, L., Yoong, S. L., Hodder, R. K., Lee, H., Robson, E. K., Haskins, R., Rissel, C., Wiggers, J., & Williams, C. M. (2019). Economic evaluation of a healthy lifestyle intervention for chronic low back pain: A randomized controlled trial. European Journal of Pain, 23(3), 621-634. https://doi.org/10.1002/ejp.1334

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abstract = "BACKGROUND: Economic evaluations which estimate cost-effectiveness of potential treatments can guide decisions about real-world healthcare services. We performed an economic evaluation of a healthy lifestyle intervention targeting weight loss, physical activity and diet for patients with chronic low back pain, who are overweight or obese.METHODS: Eligible patients with chronic low back pain (n = 160) were randomized to an intervention or usual care control group. The intervention included brief advice, a clinical consultation and referral to a 6-month telephone-based healthy lifestyle coaching service. The primary outcome was quality-adjusted life years (QALYs). Secondary outcomes were pain intensity, disability, weight and body mass index. Costs included intervention costs, healthcare utilization costs and work absenteeism costs. An economic analysis was performed from the societal perspective.RESULTS: Mean total costs were lower in the intervention group than the control group (-$614; 95%CI: -3133 to 255). The intervention group had significantly lower healthcare costs (-$292; 95%CI: -872 to -33), medication costs (-$30; 95%CI: -65 to -4) and absenteeism costs (-$1,000; 95%CI: -3573 to -210). For all outcomes, the intervention was on average less expensive and more effective than usual care, and the probability of the intervention being cost-effective compared to usual care was relatively high (i.e., 0.81) at a willingness-to-pay of $0/unit of effect. However, the probability of cost-effectiveness was not as favourable among sensitivity analyses.CONCLUSIONS: The healthy lifestyle intervention seems to be cost-effective from the societal perspective. However, variability in the sensitivity analyses indicates caution is needed when interpreting these findings.SIGNIFICANCE: This is an economic evaluation of a randomized controlled trial of a healthy lifestyle intervention for chronic low back pain. The findings suggest that a healthy lifestyle intervention may be cost-effective relative to usual care.",

author = "Amanda Williams and {van Dongen}, {Johanna M} and Kamper, {Steven J} and O'Brien, {Kate M} and Luke Wolfenden and Yoong, {Sze L} and Hodder, {Rebecca K} and Hopin Lee and Robson, {Emma K} and Robin Haskins and Chris Rissel and John Wiggers and Williams, {Christopher M}",

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doi = "10.1002/ejp.1334",

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AU - Williams, Amanda

AU - van Dongen, Johanna M

AU - Kamper, Steven J

AU - O'Brien, Kate M

AU - Wolfenden, Luke

AU - Yoong, Sze L

AU - Hodder, Rebecca K

AU - Lee, Hopin

AU - Robson, Emma K

AU - Haskins, Robin

AU - Rissel, Chris

AU - Wiggers, John

AU - Williams, Christopher M

PY - 2019/3

Y1 - 2019/3

N2 - BACKGROUND: Economic evaluations which estimate cost-effectiveness of potential treatments can guide decisions about real-world healthcare services. We performed an economic evaluation of a healthy lifestyle intervention targeting weight loss, physical activity and diet for patients with chronic low back pain, who are overweight or obese.METHODS: Eligible patients with chronic low back pain (n = 160) were randomized to an intervention or usual care control group. The intervention included brief advice, a clinical consultation and referral to a 6-month telephone-based healthy lifestyle coaching service. The primary outcome was quality-adjusted life years (QALYs). Secondary outcomes were pain intensity, disability, weight and body mass index. Costs included intervention costs, healthcare utilization costs and work absenteeism costs. An economic analysis was performed from the societal perspective.RESULTS: Mean total costs were lower in the intervention group than the control group (-$614; 95%CI: -3133 to 255). The intervention group had significantly lower healthcare costs (-$292; 95%CI: -872 to -33), medication costs (-$30; 95%CI: -65 to -4) and absenteeism costs (-$1,000; 95%CI: -3573 to -210). For all outcomes, the intervention was on average less expensive and more effective than usual care, and the probability of the intervention being cost-effective compared to usual care was relatively high (i.e., 0.81) at a willingness-to-pay of $0/unit of effect. However, the probability of cost-effectiveness was not as favourable among sensitivity analyses.CONCLUSIONS: The healthy lifestyle intervention seems to be cost-effective from the societal perspective. However, variability in the sensitivity analyses indicates caution is needed when interpreting these findings.SIGNIFICANCE: This is an economic evaluation of a randomized controlled trial of a healthy lifestyle intervention for chronic low back pain. The findings suggest that a healthy lifestyle intervention may be cost-effective relative to usual care.

AB - BACKGROUND: Economic evaluations which estimate cost-effectiveness of potential treatments can guide decisions about real-world healthcare services. We performed an economic evaluation of a healthy lifestyle intervention targeting weight loss, physical activity and diet for patients with chronic low back pain, who are overweight or obese.METHODS: Eligible patients with chronic low back pain (n = 160) were randomized to an intervention or usual care control group. The intervention included brief advice, a clinical consultation and referral to a 6-month telephone-based healthy lifestyle coaching service. The primary outcome was quality-adjusted life years (QALYs). Secondary outcomes were pain intensity, disability, weight and body mass index. Costs included intervention costs, healthcare utilization costs and work absenteeism costs. An economic analysis was performed from the societal perspective.RESULTS: Mean total costs were lower in the intervention group than the control group (-$614; 95%CI: -3133 to 255). The intervention group had significantly lower healthcare costs (-$292; 95%CI: -872 to -33), medication costs (-$30; 95%CI: -65 to -4) and absenteeism costs (-$1,000; 95%CI: -3573 to -210). For all outcomes, the intervention was on average less expensive and more effective than usual care, and the probability of the intervention being cost-effective compared to usual care was relatively high (i.e., 0.81) at a willingness-to-pay of $0/unit of effect. However, the probability of cost-effectiveness was not as favourable among sensitivity analyses.CONCLUSIONS: The healthy lifestyle intervention seems to be cost-effective from the societal perspective. However, variability in the sensitivity analyses indicates caution is needed when interpreting these findings.SIGNIFICANCE: This is an economic evaluation of a randomized controlled trial of a healthy lifestyle intervention for chronic low back pain. The findings suggest that a healthy lifestyle intervention may be cost-effective relative to usual care.

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Economic evaluation of a healthy lifestyle intervention for chronic low back pain: A randomized controlled trial

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