Factors associated with costs and health outcomes in patients with Back and leg pain in primary care: a prospective cohort analysis

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Abstract

Background

There is limited research on the economic burden of low back-related leg pain, including sciatica. The aim of this study was to describe healthcare resource utilisation and factors associated with cost and health outcomes in primary care patients consulting with symptoms of low back-related leg pain including sciatica.

Methods

This study is a prospective cohort of 609 adults visiting their family doctor with low back-related leg pain, with or without sciatica in a United Kingdom (UK) Setting. Participants completed questionnaires, underwent clinical assessments, received an MRI scan, and were followed-up for 12-months. The economic analysis outcome was the quality-adjusted life year (QALY) calculated from the EQ-5D-3 L data obtained at baseline, 4 and 12-months. Costs were measured based on patient self-reported information on resource use due to back-related leg pain and results are presented from a UK National Health Service (NHS) and Societal perspective. Factors associated with costs and outcomes were obtained using a generalised linear model.

Results

Base-case results showed improved health outcomes over 12-months for the whole cohort and slightly higher QALYs for patients in the sciatica group. NHS resource use was highest for physiotherapy and GP visits, and work-related productivity loss highest from a societal perspective. The sciatica group was associated with significantly higher work-related productivity costs. Cost was significantly associated with factors such as self-rated general health and care received as part of the study, while quality of life was significantly predicted by self-rated general health, and pain intensity, depression, and disability scores.

Conclusions

Our results contribute to understanding the economics of low back- related leg pain and sciatica and may provide guidance for future actions on cost reduction and health care improvement strategies.

Trial registration

13/09/2011 Retrospectively registered; ISRCTN62880786.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4257-0) contains supplementary material, which is available to authorized users.

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Most cited references 20

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Prognostic factors for duration of sick leave in patients sick listed with acute low back pain: a systematic review of the literature.

Ivan A Steenstra, P Bongers, J. Verbeek … (2005)

The percentages of patients with acute low back pain (LBP) that go on to a chronic state varies between studies from 2% to 34%. In some of these cases low back pain leads to great costs. To evaluate the evidence for prognostic factors for return to work among workers sick listed with acute LBP. Systematic literature search with a quality assessment of studies, assessment of levels of evidence for all factors, and pooling of effect sizes. Inclusion of studies in the review was restricted to inception cohort studies of workers with LBP on sick leave for less than six weeks, with the outcome measured in absolute terms, relative terms, survival curve, or duration of sick leave. Of the studies, 18 publications (14 cohorts) fulfilled all inclusion criteria. One low quality study, four moderate quality studies, and nine high quality studies were identified; 79 prognostic factors were studied and grouped in eight categories for which the evidence was assessed. Specific LBP, higher disability levels, older age, female gender, more social dysfunction and more social isolation, heavier work, and receiving higher compensation were identified as predictors for a longer duration of sick leave. A history of LBP, job satisfaction, educational level, marital status, number of dependants, smoking, working more than 8 hour shifts, occupation, and size of industry or company do not influence duration of sick leave due to LBP. Many different constructs were measured to identify psychosocial predictors of long term sick leave, which made it impossible to determine the role of these factors.

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The economic burden of low back pain: a review of studies published between 1996 and 2001.

Linda C. Li, Andreas Maetzel (2001)

Low back pain (LBP) poses an economic burden to society, mainly in terms of the large number of work days lost by a small percentage of patients who develop chronic LBP. The object of this review is to gain a better understanding of the societal costs of LBP and to see whether current clinical management follows evidence-based guidelines and is economically attractive, by reviewing studies on LBP with economic implications. To this end, the Medline database was searched between 1996 and 2001 using appropriate keywords, broadly defined. A total of 372 abstracts were screened and paper copies of 73 potentially relevant articles were obtained. It was found that the cost of LBP illness was high and was comparable to other disorders such as headache, heart disease, depression or diabetes, but actual cost estimates varied depending on the costing methodology employed. A small percentage of patients with chronic LBP accounts for a large fraction of the costs. Excessive and inappropriate use of diagnostic or therapeutic services can be documented but varied by region and provider type. Management according to evidence-based guidelines was not necessarily economically attractive. Interventions for acute or chronic LBP failed to show economic benefits, but demonstrated modest clinical benefits, which suggested a weak relationship between clinical and economic outcomes. The conclusion was that common definitions and costing methodologies need to be found to gain a better understanding of the true costs to society and to make studies comparable. A better definition is needed for the type for patient with LBP for whom therapeutic management is most likely to have a long-lasting economic benefit.

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Low back pain and sciatica: summary of NICE guidance.

Ian Bernstein, Qudsia Malik, Serena Carville … (2017)

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Author and article information

Contributors

Jesse Kigozi:

ORCID: http://orcid.org/0000-0001-7608-4923

j.kigozi@bham.ac.uk

Kika Konstantinou: k.konstantinou@keele.ac.uk

Reuben Ogollah: Reuben.Ogollah@nottingham.ac.uk

Kate Dunn: k.m.dunn@keele.ac.uk

Lewis Martyn: a.m.lewis@keele.ac.uk

Susan Jowett: S.JOWETT@bham.ac.uk

Journal

Journal ID (nlm-ta): BMC Health Serv Res

Journal ID (iso-abbrev): BMC Health Serv Res

Title: BMC Health Services Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6963

Publication date (Electronic): 21 June 2019

Publication date PMC-release: 21 June 2019

Publication date Collection: 2019

Volume: 19

Electronic Location Identifier: 406

Affiliations

[1 ]ISNI 0000 0004 1936 7486, GRID grid.6572.6, Health Economics Unit, Institute of Applied Health Research, , University of Birmingham, ; Edgbaston, Birmingham, B15 2TT UK

[2 ]ISNI 0000 0004 0415 6205, GRID grid.9757.c, Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, , Keele University, ; Keele, Staffordshire UK

[3 ]ISNI 0000 0004 0415 6205, GRID grid.9757.c, Keele Clinical Trials Unit, David Weatherall Building, , Keele University, ; Keele, Staffordshire ST5 5BG UK

[4 ]ISNI 0000 0004 1936 8868, GRID grid.4563.4, Nottingham Clinical Trials Unit, School of Medicine, , University of Nottingham, ; Nottingham, NG7 2UH UK

Author information

Jesse Kigozi http://orcid.org/0000-0001-7608-4923

Article

Publisher ID: 4257

DOI: 10.1186/s12913-019-4257-0

PMC ID: 6588896

PubMed ID: 31226997

SO-VID: 838eaa18-0d43-4ec2-8197-63e65695f84a

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 14 June 2018

Date accepted : 13 June 2019

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100007602, Programme Grants for Applied Research;

Award ID: RP-PG-0707-10131

Custom metadata

ScienceOpen disciplines: Health & Social care

Keywords: cost,outcome,back pain,leg pain,and sciatica

Data availability:

ScienceOpen disciplines: Health & Social care

Keywords: cost, outcome, back pain, leg pain, and sciatica

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Factors associated with costs and health outcomes in patients with Back and leg pain in primary care: a prospective cohort analysis

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Abstract

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Most cited references 20

Prognostic factors for duration of sick leave in patients sick listed with acute low back pain: a systematic review of the literature.

The economic burden of low back pain: a review of studies published between 1996 and 2001.

Low back pain and sciatica: summary of NICE guidance.

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