Versorgung von Rückenschmerzpatienten in hausärztlichen Praxen: Krankheitskosten und Kosten-Effektivität zweier Leitlinien-Implementierungsstrategien

Die Kreuzschmerzen (LBP) stellen eine wesentliche ökonomische Belastung des Gesundheitssystems in Industrienationen dar. Aktuelle Studien betonen die Notwendigkeit, Kreuzschmerz-Subgruppen zu identifizieren. Diese sollen dazu dienen, effektive Handlungsstrategien, die die Wirksamkeit erhöhen und Kos...

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Bibliographic Details
Main Author: Held, Heiko
Contributors: Becker, Annette (Prof. Dr. med) (Thesis advisor)
Format: Doctoral Thesis
Published: Philipps-Universität Marburg 2010
Online Access:PDF Full Text
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Table of Contents: The low back pain (LBP) represent a substantial economic burden on health care in industrialized nations. Recent studies emphasize the need to identify back pain subgroups. These are intended to design effective strategies that increase the effectiveness and reduce costs. These secondary studies related to data and results of controlled, cluster-randomized study of Becker et al. (2008). In this study, 1378 patients (12.1% drop out) in general practices (n = 118 practices, 1-20 patients per practice, mean 11.8, SD + / - 5.8) recruited . The socio-demographic data were inquired by questionnaire and telephone interview at baseline and after a follow-up six and twelve months later. These secondary studies is calculated from a societal perspective and from bottom-up approach. There are indirect costs such as doctor contact, treatment, medication, tests and Aids, hospital and rehabilitation stays and direct cost. The assessment of prices refers to the year 2004. Patients with chronic low back pain account for approximately two thirds of the cost. For 80% of the total cost is a small group of patients (20%) responsible. A high grad of chronicity (von Korff, grade IV) is the most important predictor of high direct, indirect and total costs. Other predictors of high total costs are depression and its own forecast of the patient to return to work and of high direct costs radiation of pain in one leg. The cost-effectiveness in the context of guidelines implementation regarding functional capacity and quality of life shows an advantage of the MC-study arm (guideline + motivational counselling) compared with the LL-study arm (guideline). In the assessment of days of pain the reverse is true. A bootstrap analysis can confirm a trend of superiority of the MC-to the LL group. Regarding the cost of supply no advantage over the control group is evident. The present study adds important information to understand the composition of expenditure and relevant predictors of high health costs. Not only the severity of the disease, but also the high level of fear avoidance beliefs plays an important role. For Health economic especially workers as patients are important because they cause by their disease and the associated workplace absences high costs Because of the unequal starting point of the study arms at baseline an interpretation is difficult. Overall, however, the trend shows that the MC-group of the LL-group is superior in cost effectiveness, though not significantly. More and larger studies are needed to provide information to confirm on potential predictors of the disease or supplement to them to contribute to health policy decision and to confirm the superiority of the motivational counselling as part of a guideline implementation compared to the simple guideline implementation.