Joined-up care for people with low back pain saves money

An integrated approach to care for people on long term sick leave because of chronic low back pain has substantially lower costs than usual care, finds a study published in the British Medical Journal today.

Researchers in the Netherlands found that an integrated care approach has significant benefits for patients, society and employers.

Chronic low back pain is one of the most common health problems in industrialised countries and places a huge economic burden on individuals, health care systems, and society as a whole. Most (93%) of this burden is related to costs of productivity losses.

The researchers identified 134 patients aged 18 to 65 years who were on sick leave from work because of chronic low back pain. Sixty-six patients received an integrated care programme, while 68 patients received usual care according to Dutch guidelines.

Integrated care consisted of workplace assessments, treatment with graded exercise, and reassurance that despite pain, moving can be safe while increasing activity levels (for full details of the intervention see http://www.bmj.com/content/340/bmj.c1035/suppl/DC1). The main aims of the programme were to achieve lasting return to work and improved quality of life, and these results were published in the BMJ in March 2010.

The patients were surveyed at regular intervals over 12 months to assess their use of health care resources and absenteeism from work.

Usual care patients consulted health care professionals more often than patients who received integrated care, and they used more informal care and had longer stays in hospital. Sustainable return to work and quality of life gained were also significantly more favourable in the integrated care group compared with usual care.

After 12 months, total costs in the integrated care group (£13,165) were significantly lower than in the usual care group (£18,475). Integrated care was therefore more cost effective than usual care. Cost-benefit analyses showed that every £1 invested in integrated care will return an estimated £26. For society, the net benefit of integrated care compared with usual care was £5,744.

Limited health care budgets are making economic evaluations increasingly important, say the authors. The integrated care programme has large potential to significantly reduce societal costs and improve quality of life and function. They conclude: "The success and failures of implementing the integrated care programme need to be investigated to determine the boundary conditions for nationwide application."