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Economic evaluation of an implementation strategy for the management of low back pain in general practice

Jensen, Cathrine Elgaarda,*; Riis, Allanb; Petersen, Karin Dama; Jensen, Martin Bachb; Pedersen, Kjeld Møllera,c

doi: 10.1097/j.pain.0000000000000851
Research Paper

In connection with the publication of a clinical practice guideline on the management of low back pain (LBP) in general practice in Denmark, a cluster randomised controlled trial was conducted. In this trial, a multifaceted guideline implementation strategy to improve general practitioners' treatment of patients with LBP was compared with a usual implementation strategy. The aim was to determine whether the multifaceted strategy was cost effective, as compared with the usual implementation strategy. The economic evaluation was conducted as a cost–utility analysis where cost collected from a societal perspective and quality-adjusted life years were used as outcome measures. The analysis was conducted as a within-trial analysis with a 12-month time horizon consistent with the follow-up period of the clinical trial. To adjust for a priori selected covariates, generalised linear models with a gamma family were used to estimate incremental costs and quality-adjusted life years. Furthermore, both deterministic and probabilistic sensitivity analyses were conducted. Results showed that costs associated with primary health care were higher, whereas secondary health care costs were lower for the intervention group when compared with the control group. When adjusting for covariates, the intervention was less costly, and there was no significant difference in effect between the 2 groups. Sensitivity analyses showed that results were sensitive to uncertainty. In conclusion, the multifaceted implementation strategy was cost saving when compared with the usual strategy for implementing LBP clinical practice guidelines in general practice. Furthermore, there was no significant difference in effect, and the estimate was sensitive to uncertainty.

Supplemental Digital Content is Available in the Text.Using a multifaceted strategy for implementing low back pain guidelines in general practice was cost saving.

aDanish Center for Healthcare Improvements, Faculty of Social Sciences, Department of Business and Management, Aalborg University, Aalborg, Denmark

bResearch Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

cCentre of Health Economics Research, Faculty of Business and Social Sciences, Department of Business and Economics and Department of Public Health University of Southern Denmark, Odense, Denmark

Corresponding author. Address: Danish Center for Healthcare Improvements, Aalborg University, Fibigerstræde 11, room 68, DK-9220, Denmark. Tel.: +45 99402734. E-mail address: (C. E. Jensen).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received July 08, 2016

Received in revised form January 02, 2017

Accepted January 09, 2017

© 2017 International Association for the Study of Pain
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