Daniel I Rhon, Minchul Kim, Carl Asche, Steven Z George
{"title":"军队医疗系统中腰背痛风险分层护理与常规护理的成本效益对比。","authors":"Daniel I Rhon, Minchul Kim, Carl Asche, Steven Z George","doi":"10.1097/BRS.0000000000005145","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>Cost-effectiveness of two trial interventions for low back pain.</p><p><strong>Objective: </strong>To investigate the incremental cost-effectiveness between risk-stratified and usual care for low back pain.</p><p><strong>Summary of background data: </strong>A recent trial compared risk-stratified care to usual care for patients with low back pain (LBP) in the US Military Health System. While the outcomes were no different between groups, risk-stratified care is purported to use fewer resources and therefore could be a more cost-effective intervention. Risk-stratified care matches treatment based on low, medium, or high risk for poor prognosis.</p><p><strong>Methods: </strong>The cost-effectiveness of usual care versus risk-stratified care for low back pain was assessed, using the health care perspective. Patients were recruited from primary care. The main outcome indicated incremental cost-effectiveness between two alternative treatments. Acceptability curves of bootstrapped incremental cost-effectiveness ratios (ICER) were used to identify the proportion of ICERs under the specific willingness-to-pay (WTP) level ($50,000 to $100,000). Health system costs (total and back-related) and health-related quality-of-life (HRQoL) based on quality-adjusted life-years (QALYs) were obtained.</p><p><strong>Results: </strong>Two hundred seventy-one participants (33.6% female), mean age 34.3 +/-8.7 were randomized 1:1 and followed for one year. Mean back-related medical costs were not significantly different (mean difference $95; 95% CI: -$398, $407; P =0.982), nor were total medical costs (mean difference $827, 95% CI: -$1748, $3403; P =0.529). The mean difference in QALYs was not significantly different between groups (0.009; 95% CI: -0.014, 0.032; P =0.459). The incremental net monetary benefit (NMB) at the willingness to pay (WTP) threshold of $100,000 was $792 for back-related costs, with the lower bound CI negative at all WTP levels.</p><p><strong>Conclusions: </strong>Risk-stratified care was not cost-effective for medium-risk and low-risk individuals compared with usual care. Further research is needed to assess whether there is value for high-risk individuals or for other risk-stratification approaches.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E270-E277"},"PeriodicalIF":2.6000,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Cost-effectiveness of Risk Stratified Care Versus Usual Care for Low Back Pain in the Military Health System.\",\"authors\":\"Daniel I Rhon, Minchul Kim, Carl Asche, Steven Z George\",\"doi\":\"10.1097/BRS.0000000000005145\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study design: </strong>Cost-effectiveness of two trial interventions for low back pain.</p><p><strong>Objective: </strong>To investigate the incremental cost-effectiveness between risk-stratified and usual care for low back pain.</p><p><strong>Summary of background data: </strong>A recent trial compared risk-stratified care to usual care for patients with low back pain (LBP) in the US Military Health System. While the outcomes were no different between groups, risk-stratified care is purported to use fewer resources and therefore could be a more cost-effective intervention. Risk-stratified care matches treatment based on low, medium, or high risk for poor prognosis.</p><p><strong>Methods: </strong>The cost-effectiveness of usual care versus risk-stratified care for low back pain was assessed, using the health care perspective. Patients were recruited from primary care. The main outcome indicated incremental cost-effectiveness between two alternative treatments. Acceptability curves of bootstrapped incremental cost-effectiveness ratios (ICER) were used to identify the proportion of ICERs under the specific willingness-to-pay (WTP) level ($50,000 to $100,000). Health system costs (total and back-related) and health-related quality-of-life (HRQoL) based on quality-adjusted life-years (QALYs) were obtained.</p><p><strong>Results: </strong>Two hundred seventy-one participants (33.6% female), mean age 34.3 +/-8.7 were randomized 1:1 and followed for one year. Mean back-related medical costs were not significantly different (mean difference $95; 95% CI: -$398, $407; P =0.982), nor were total medical costs (mean difference $827, 95% CI: -$1748, $3403; P =0.529). The mean difference in QALYs was not significantly different between groups (0.009; 95% CI: -0.014, 0.032; P =0.459). The incremental net monetary benefit (NMB) at the willingness to pay (WTP) threshold of $100,000 was $792 for back-related costs, with the lower bound CI negative at all WTP levels.</p><p><strong>Conclusions: </strong>Risk-stratified care was not cost-effective for medium-risk and low-risk individuals compared with usual care. Further research is needed to assess whether there is value for high-risk individuals or for other risk-stratification approaches.</p>\",\"PeriodicalId\":22193,\"journal\":{\"name\":\"Spine\",\"volume\":\" \",\"pages\":\"E270-E277\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2025-07-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Spine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/BRS.0000000000005145\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/9/6 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Spine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BRS.0000000000005145","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/9/6 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Cost-effectiveness of Risk Stratified Care Versus Usual Care for Low Back Pain in the Military Health System.
Study design: Cost-effectiveness of two trial interventions for low back pain.
Objective: To investigate the incremental cost-effectiveness between risk-stratified and usual care for low back pain.
Summary of background data: A recent trial compared risk-stratified care to usual care for patients with low back pain (LBP) in the US Military Health System. While the outcomes were no different between groups, risk-stratified care is purported to use fewer resources and therefore could be a more cost-effective intervention. Risk-stratified care matches treatment based on low, medium, or high risk for poor prognosis.
Methods: The cost-effectiveness of usual care versus risk-stratified care for low back pain was assessed, using the health care perspective. Patients were recruited from primary care. The main outcome indicated incremental cost-effectiveness between two alternative treatments. Acceptability curves of bootstrapped incremental cost-effectiveness ratios (ICER) were used to identify the proportion of ICERs under the specific willingness-to-pay (WTP) level ($50,000 to $100,000). Health system costs (total and back-related) and health-related quality-of-life (HRQoL) based on quality-adjusted life-years (QALYs) were obtained.
Results: Two hundred seventy-one participants (33.6% female), mean age 34.3 +/-8.7 were randomized 1:1 and followed for one year. Mean back-related medical costs were not significantly different (mean difference $95; 95% CI: -$398, $407; P =0.982), nor were total medical costs (mean difference $827, 95% CI: -$1748, $3403; P =0.529). The mean difference in QALYs was not significantly different between groups (0.009; 95% CI: -0.014, 0.032; P =0.459). The incremental net monetary benefit (NMB) at the willingness to pay (WTP) threshold of $100,000 was $792 for back-related costs, with the lower bound CI negative at all WTP levels.
Conclusions: Risk-stratified care was not cost-effective for medium-risk and low-risk individuals compared with usual care. Further research is needed to assess whether there is value for high-risk individuals or for other risk-stratification approaches.
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Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.
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