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Relative Cost-Effectiveness of Extensive and Light Multidisciplinary Treatment Programs Versus Treatment as Usual for Patients With Chronic Low Back Pain on Long-Term Sick Leave: Randomized Controlled Study

Skouen, Jan S. MD, PhD*; Grasdal, Astrid L. PhD; Haldorsen, Ellen M. H. PhD*; Ursin, Holger MD, PhD

Randomized Trial

Study Design. A subgroup of 195 patients with chronic low back pain, being part of a larger study of other musculoskeletal patients, were included in a randomized controlled prospective clinical study.

Objectives. To evaluate the outcome in terms of return to work and cost-effectiveness of a light multidisciplinary treatment program with an extensive multidisciplinary program and treatment as usual initiated by their general practitioner.

Summary of Background Data. Light multidisciplinary programs seem to reduce sick leave in patients with subacute low back pain. There are few, if any, previous studies of the effectiveness of light versus extensive multidisciplinary treatment on return to work in patients with chronic low back pain.

Methods. Patients with chronic low back pain (n = 195), on an average sick-listed for 3 months, were included. The patients were randomized to a light multidisciplinary treatment program, an extensive multidisciplinary program, or treatment as usual by their primary physician. Full return to work was used as outcome response, and follow-up was 26 months after the end of treatment. Cost–benefit was calculated for the treatment programs.

Results. In men significantly better results for full return to work were found for the light multidisciplinary treatment compared with treatment as usual, but no differences were found between extensive multidisciplinary treatment and treatment as usual. No significant differences between any of the two multidisciplinary treatment programs and the controls were found for women. Productivity gains for the society from light multidisciplinary treatment versus “treatment as usual” of 57 male patients with low back pain would during the first 2 years accumulate to U.S. $852.000.

Conclusions. The light multidisciplinary treatment model is a cost-effective treatment for men with chronic low back pain.

From the *Outpatient Spine Clinic, Haukeland University Hospital, and the Departments of

†Economics and

‡Biological and Medical Psychology, Division of Physiological Psychology, University of Bergen, Bergen, Norway.

Supported by the Royal Norwegian Ministry of Health and Social Affairs.

Acknowledgment date: July 11, 2000.

First revision date: November 27, 2000.

Second revision date: June 20, 2001.

Acceptance date: October 24, 2001.

Device status category: 1.

Conflict of interest category: 14.

Address correspondence to

Jan Sture Skouen, MD, PhD

Outpatient Spine Clinic

Haukeland University Hospital

5021 Bergen, Norway

E-mail: jssk@haukeland.no

© 2002 Lippincott Williams & Wilkins, Inc.