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Cost-Effectiveness of Lumbar Supports for Home Care Workers With Recurrent Low Back Pain: An Economic Evaluation Alongside a Randomized-Controlled Trial

Roelofs, Pepijn D. D. M., PhD*; Bierma-Zeinstra, Sita M. A., PhD*; van Poppel, Mireille N. M., PhD†‡; van Mechelen, Willem, MD, PhD†‡; Koes, Bart W., PhD*; van Tulder, Maurits W., PhD§¶

doi: 10.1097/BRS.0b013e3181cf7244
Health Services Research

Study Design. Economic evaluation from a societal perspective alongside a 12-months randomized-controlled trial.

Objective. To determine the cost-effectiveness of wearing a lumbar support for home care workers with recurrent low back pain (LBP) (secondary prevention).

Summary of Background Data. LBP is a large medical and economical burden. Evidence on the secondary preventive use of lumbar supports is sparse.

Methods. A total of 360 home care workers with a self-reported history of LBP were randomly assigned to usual care or usual care plus wearing a lumbar support on working days with LBP, during a 1-year period. Primary clinical outcome measures were the average number of self-reported days with LBP, number of calendar days sick leave in general, and quality of life. Direct and indirect costs were measured by means of cost diaries. Differences in mean costs between groups, cost-effectiveness, and cost-utility ratios were evaluated, and cost-effectiveness planes and acceptability curves presented by applying nonparametric bootstrapping techniques.

Results. During the intervention period, the home care workers using a lumbar support in addition to usual care reported on average 54 fewer days with LBP (95% confidence interval [CI], −85 to −29). The estimated mean difference in sick leave was not statistically significant (−5.0 days per year in favor of the lumbar support group; 95% CI, −21.1 to 6.8). There was no statistically significant difference in quality of life. Direct costs were €235 (US$ 266) lower in the lumbar support group (95% CI, −386 to −79). Indirect costs were €255 (US$ 288) lower, but this was not statistically significant (95% CI, −879 to 299).

Conclusion. Lumbar support seems to be a cost-effective addition to usual care for home care workers with recurrent LBP. For estimating the LBP-related indirect costs, it would be more precise when an objective measure for LBP-related sick leave would have been available. There is a need for more evidence to confirm these findings, also in other working populations.

To determine the cost-effectiveness of wearing a lumbar support for home care workers with recurrent low back pain, an economic evaluation from a societal perspective was conducted alongside Randomized-Controlled Trial. Workers using a lumbar support in addition to usual care reported less days with low back pain at lower costs.

From the *Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; †Department of Public and Occupational Health, EMGO Institute, VU University Medical Centre, Amsterdam, the Netherlands; ‡Body@Work, Research Center Physical Activity, Work and Health, TNO-VUmc, Hoofddorp-Amsterdam, The Netherlands; §EMGO Institute, VU University Medical Center, Amsterdam, the Netherlands; and ¶Faculty of Earth & Life Sciences, Institute of Health Sciences, VU University, Amsterdam, the Netherlands.

Acknowledgment date: February 23, 2009. Revision date: September 24, 2009. Acceptance date: December 7, 2009.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Supported by The ZonMW Thuiszorgtechnologie Fonds. ZonMw is the national health council appointed by the Ministry of Health (VWS) and the Netherlands Organization for Scientific Research (NWO) to promote quality and innovation in the field of health research and care. Used lumbar supports were supplied free of charge by Bauerfeind B.V., Haarlem, The Netherlands. ZonMW and Bauerfeind B.V. have not played a role in the design, conduct and analysis of this study, nor in the decision to submit the manuscript for publication.

Research Ethics Committee, The Medical Ethical Committee of the Erasmus University Medical Center, Rotterdam approved the study.

ISRCTN registration number: ISRCTN73707379.

Address correspondence and reprint requests to Pepijn D. D. M. Roelofs, Department of General Practice, Room WK109, Erasmus Medical Center, University Medical Center Rotterdam, PO Box 2040, NL-3000 CA Rotterdam, the Netherlands; E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.