Takashi Kaito1, Yukihiro Matsuyama2, Toshihiko Yamashita3, Mamoru Kawakami4, Kazuhisa Takahashi5, Munehito Yoshida6, Shiro Imagama7, Seiji Ohtori5, Toshihiko Taguchi8, Hirotaka Haro9, Hiroshi Taneichi10, Masashi Yamazaki11, Gen Inoue12, Kotaro Nishida13, Hiroshi Yamada14, Daijiro Kabata15, Ayumi Shintani15, Motoki Iwasaki16, Manabu Ito17, Naohisa Miyakoshi18, Hideki Murakami19, Kazuo Yonenobu20, Tomoyuki Takura21, Joji Mochida22. 1. Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan. Electronic address: takashikaito@ort.med.osaka-u.ac.jp. 2. Division of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan. 3. Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan. 4. Spine Care Center, Wakayama Medical University Kihoku Hospital, Katsuragi-cho, Japan. 5. Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan. 6. Sumiya Orthopaedic Hospital. Wakayama, Japan. 7. Department of Orthopaedics/Rheumatology, Nagoya University Graduate School of Medicine, Japan. 8. Department of Orthopaedic Surgery, Yamaguchi Rosai Hospital, Sanyoonoda, Japan. 9. Department of Orthopaedic Surgery, University of Yamanashi, Cyuo, Japan. 10. Department of Orthopaedic Surgery, Dokkyo Medical University, Mibumachi, Japan. 11. Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Japan. 12. Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan. 13. Department of Orthopaedic Surgery, University of the Ryukyus, Faculty of Medicine, Nishihara, Japan. 14. Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan. 15. Department of Medical Statistics, Osaka City University Graduate School of Medicine and Faculty of Medicine, Osaka, Japan. 16. Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Japan. 17. Department of Orthopaedic Surgery, National Hospital Organization, Hokkaido Medical Center, Sapporo, Japan. 18. Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan. 19. Department of Orthopaedic Surgery, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan. 20. Osaka Yukioka College of Health Science, Japan. 21. Department of Healthcare Economics and Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 22. Department of Orthopaedic Surgery, Japan Medical Alliance, Ebina General Hospital, Ebina, Japan.
Abstract
BACKGROUND: Chronic low back pain is a major health problem that has a substantial effect on people's quality of life and places a significant economic burden on healthcare systems. However, there has been little cost-effectiveness analysis of the treatments for it. Therefore, the purpose of this prospective observational study was to evaluate the cost-effectiveness of the pharmacological management of chronic low back pain. METHODS: A total of 474 patients received pharmacological management for chronic low back pain using four leading drugs for 6 months at 28 institutions in Japan. Outcome measures, including EQ-5D, the Japanese Orthopaedic Association (JOA) score, the JOA back pain evaluation questionnaire (BPEQ), the Roland-Morris Disability Questionnaire, the Medical Outcomes Study SF-8, and the visual analog scale, were investigated at baseline and every one month thereafter. The incremental cost-utility ratio (ICUR) was calculated as drug cost over the quality-adjusted life years. An economic estimation was performed from the perspective of a public healthcare payer in Japan. Stratified analysis based on patient characteristics was also performed to explore the characteristics that affect cost-effectiveness. RESULTS: The ICUR of pharmacological management for chronic low back pain was JPY 453,756. Stratified analysis based on patient characteristics suggested that the pharmacological treatments for patients with a history of spine surgery or cancer, low frequency of exercise, long disease period, low scores in lumbar spine dysfunction and gait disturbance of the JOA BPEQ, and low JOA score at baseline were not cost-effective. CONCLUSIONS: Pharmacological management for chronic low back pain is cost-effective from the reference willingness to pay. Further optimization based on patient characteristics is expected to contribute to the sustainable development of a universal insurance system in Japan.
BACKGROUND: Chronic low back pain is a major health problem that has a substantial effect on people's quality of life and places a significant economic burden on healthcare systems. However, there has been little cost-effectiveness analysis of the treatments for it. Therefore, the purpose of this prospective observational study was to evaluate the cost-effectiveness of the pharmacological management of chronic low back pain. METHODS: A total of 474 patients received pharmacological management for chronic low back pain using four leading drugs for 6 months at 28 institutions in Japan. Outcome measures, including EQ-5D, the Japanese Orthopaedic Association (JOA) score, the JOA back pain evaluation questionnaire (BPEQ), the Roland-Morris Disability Questionnaire, the Medical Outcomes Study SF-8, and the visual analog scale, were investigated at baseline and every one month thereafter. The incremental cost-utility ratio (ICUR) was calculated as drug cost over the quality-adjusted life years. An economic estimation was performed from the perspective of a public healthcare payer in Japan. Stratified analysis based on patient characteristics was also performed to explore the characteristics that affect cost-effectiveness. RESULTS: The ICUR of pharmacological management for chronic low back pain was JPY 453,756. Stratified analysis based on patient characteristics suggested that the pharmacological treatments for patients with a history of spine surgery or cancer, low frequency of exercise, long disease period, low scores in lumbar spine dysfunction and gait disturbance of the JOA BPEQ, and low JOA score at baseline were not cost-effective. CONCLUSIONS: Pharmacological management for chronic low back pain is cost-effective from the reference willingness to pay. Further optimization based on patient characteristics is expected to contribute to the sustainable development of a universal insurance system in Japan.