Purpose and Study Design: Retrospective cohort cost-minimization analysis (payer perspective) with decision analysis model to access cost-effectiveness of a treatment-based algorithm (TBC) for low back pain (LBP) compared to a usual care strategy in the outpatient setting.
Methods: charge data was examined on 750 subjects with LBP from 42 regional clinics over 1 year period. Subjects were determined to be on or off protocol for the classification algorithms based on provider responses to minimum required initial exam and history intake data and subsequent interventions provided. Primary outcome measures were total net direct health care and physical therapy costs, along with total member and physical therapy member burden costs. In addition, protocol status was examined as a predictor variable for the following: top quartile of total direct health care and physical therapy expenditures, as well as total direct health care and physical therapy member burden. A 4% / yearly discounting rate was applied.
Results: Baseline characteristics of the combined sample demonstrated a significant proportion of Medical Assistance patients were given non-adherent care. In addition, a significant but not clinical difference was found in fear-avoidance behavioral questionnaire physical activity (FABQ_PA) scores. Incremental cost-savings were demonstrated in all primary outcome measures for the combined sample. The specific exercise and flexion off-protocol subgroups demonstrated member burden savings but this was explained exclusively after adjustment by having Medical Assistance as an insurance type. Off-protocol status accounted for significant variation in explaining differences in the statistically different outcomes, as well as demonstrating predictive ability for attaining the top quartile of total direct health care expenditures. The decision analysis model demonstrated the dominance of classification approach to usual care across a variety of associated variable ranges and distributions.
Conclusions: This evidence supports the TBC as a cost-effective alternative for LBP treatment compared to usual physical therapy care. It appears beneficial for a payer to adopt strategies to improve compliance with the TBC. Further recommendations are suggested to either validate or cross-validate these findings and to improve outcomes reporting. The TBC should also be compared as a cost-effective alternative to treating LBP against primary-care (non-rehabilitative) and chiropractic.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-09212009-154536 |
| Date | 11 January 2010 |
| Creators | McGee, John Christopher |
| Contributors | John D. Childs, PhD, PT, MBA, OCS, CSCS, FAAOMPT, Pamela B. Peele, PhD, G. Kelley Fitzgerald PhD, PT, FAPTA,, Anthony Delitto, PhD, PT, FAPTA, John W. Wilson, PhD, Michel Landry, PhD, MScPT |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-09212009-154536/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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