A Multidisciplinary Spine Intervention Can Significantly Reduce Costs Related to Chronic Back Pain

November 13, 2020
Laura Joszt, MA
Laura Joszt, MA

Laura is the editorial director of The American Journal of Managed Care® (AJMC®) and all its brands, including The American Journal of Accountable Care®, Evidence-Based Oncology™, and The Center for Biosimilars®. She has been working on AJMC® since 2014 and has been with AJMC®'s parent company, MJH Life Sciences, since 2011. She has an MA in business and economic reporting from New York University.

A multidisciplinary spine intervention can reduce chronic back pain–related health care utilization and costs, according to a study published in Spine.

A multidisciplinary spine intervention can reduce chronic back pain (CBP)–related health care utilization and costs, according to a study published in Spine.

Worldwide, CBP is responsible for the largest number of years lived with disability and has tremendous costs, highlighting a need for interventions that will reduce the economic burden on patients and society.

The researchers examined changes in health care costs after patients with complex CBP received multidisciplinary spine care at The Groningen Spine Center (GSC) in the Netherlands. They used a before and after study design to compare health care costs 2 years before and 2 years after the intervention.

During the first visit, 2 to 4 specialists with different focus areas assessed the complaints to identify the best treatment modality and all patients received information and advice to cope. Patients who had multifactorial CBP were offered primary care treatment, such as physiotherapy or exercise or posture therapy, or outpatient interdisciplinary rehabilitation. Patients with specific CBP based on herniated disks or stenosis were offered surgery. Patients with segmental root problems were provided anesthesiology. When indicated, some patients received a combination of the interventions.

A total of 997 patients were included in the study. They received the intervention for a mean of 201 days; 546 patients received information and explanation, 203 patients followed interdisciplinary rehabilitation, 67 underwent surgery, 141 received medication or injections, and 37 received a combination intervention. There was missing information for 3 patients, and the intervention they received was not retrieved.

Health care costs related to CBP rose before the intervention and were highest during the patients' treatment at GSC but decreased in the 2 years following, to a level below the costs 1 year before the intervention. “The majority of the reduction in CBP-related health care costs appeared to be due to a reduction in medical specialist care and allied care consumption (P <  .01),” the authors wrote.

In general, treatment was associated with a 34% (P < .01) reduction in CBP-related health care costs when comparing patients 1 and 2 years before the intervention with patients 1 and 2 years after the intervention. Controlling for biases found a smaller, but still significant reduction in costs. Patients with a higher baseline body mass index and female sex had a smaller reduction in CBP-related health care costs. In the adjusted sample, costs were reduced 21% (P < .01) in the 2 years after intervention compared with the 2 years before.

“This study provides complimentary evidence that multidisciplinary spine care could be cost-saving from an insurers’ perspective, whereas we found no differences between intervention types,” the authors wrote. “The results complement and point in the same direction as controlled studies, adding to the robustness of the observation that this type of care is beneficial from a health economic perspective.”

Reference

Soer R, Reneman MF, Mierau JO, et al. Can we change health care costs in patients with complex back pain?: results from a 5-year before and after study. Spine (Phila Pa 1976). 2020;45(20):1443-1450. doi:10.1097/BRS.0000000000003550