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Effectiveness and Cost-Effectiveness of Adding a Cognitive Behavioral Treatment to the Rehabilitation of Chronic Low Back Pain
BERND SCHWEIKERT, ECKART JACOBI, ROBERT SEITZ, REINHARD CZISKE, ANTJE EHLERT, JULIA KNAB, and REINER LEIDL ABSTRACT. Objective. To investigate return to work and cost-effectiveness of the addition of cognitive-behavioral treatment to standard therapy compared to standard 3-week inpatient rehabilitation for patients with chronic low back pain. Methods. A prospective economic evaluation alongside a randomized controlled trial was performed. Outcomes included days off work due to spinal complaints, health-related quality of life, and direct and indirect disease-related costs. Results. A total of 409 patients with chronic low back pain, who were admitted to a 3-week inpatient rehabilitation, were randomly assigned to usual care or usual care plus cognitive behavioral treatment. Average incremental costs for psychological treatment during rehabilitation were € 127 (95% CI 125.6, 130.9; p < 0.001). Six months after rehabilitation, patients in the intervention group were absent from work an average of 5.4 (95% CI –1.4, 12.1; p = 0.12) days less than patients receiving usual treatment. Between groups, there were no significant differences in quality-adjusted life-years gained or in direct medical or nonmedical costs. The cognitive behavioral treatment showed lower indirect costs: € 751 (95% CI –145, 1641; p = 0.097). Conclusion. Adding a cognitive behavioral component to standard therapy may reduce work days lost and thus decrease indirect costs. From a societal perspective, the cost of the psychological treatment was compensated by lower indirect costs. (J Rheumatol 2006;33:2519–26) Key Indexing Terms:
CHRONIC LOW BACK PAIN From GSF – National Research Center for Environment and Health, Institute of Health Economics and Health Care Management, Neuherberg; Research Institute for Rehabilitation Medicine, University Ulm, Ulm; Rheumaklinik Bad Wurzach, Bad Wurzach; BKK Landesverband Bayern (Association of Company Sickness Funds), Munich; Federseeklinik Bad Buchau, Bad Buchau; and Munich School of Management, Institute of Health Economics and Management, Ludwig-Maximilians-University, Munich, Germany. Supported by the German Federal Ministry of Education and Research and the Federation of the German Pension Insurance Institutes, grant no. 01GD9820/0. B. Schweikert, MSc, Health Economist, GSF – National Research Center for Environment and Health, Institute of Health Economics and Health Care Management; E. Jacobi, MD, PhD, Chief Physician, Medical Project Leader, Research Institute for Rehabilitation Medicine, University Ulm; Rheumaklinik Bad Wurzach; R. Seitz, PhD, Health Economist, Project Leader, BKK Landesverband Bayern; R. Cziske, MSc, Psychologist; A. Ehlert, MD, Study Physician, Rheumaklinik Bad Wurzach; J. Knab, MD, Study Physician, Federseeklinik Bad Buchau; R. Leidl, PhD, Head, Health Economics Unit, GSF – National Research Center for Environment and Health, Institute of Health Economics and Health Care Management and Munich School of Management, Institute of Health Economics and Management, Ludwig-Maximilians-University. Address reprint requests to B. Schweikert, GSF–National Research Center for Environment and Health, Institute of Health Economics and Health Care Management, Ingolstädter Landstrasse 1, D-85764 Neuherberg, Germany. E-mail: bernd.schweikert@gsf.de Accepted for publication July 20, 2006.
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