Is exposure in vivo cost-effective for chronic low back pain? A trial-based economic evaluation
Open accessAbstract
BACKGROUND: Back pain is one of the most expensive health complaints. Comparing the economic aspects of back pain interventions may therefore contribute to a more efficient use of available resources. This study reports on a long-term cost-effectiveness analysis (CEA) and cost-utility analysis (CUA) of two treatments as viewed from a societal perspective: 1) exposure in vivo treatment (EXP), a recently developed cognitive behavioral treatment for patients with chronic low back pain who have elevated pain-related fear and 2) the more commonly used graded activity (GA) treatment. METHODS: Sixty-two patients with non-specific chronic low back pain received either EXP or GA. Primary data were collected at four participating treatment centers in the Netherlands. Primary outcomes were self-reported disability (for the CEA) and quality-adjusted life years (for the CUA). Program costs, health care utilization, patient and family costs, and production losses were measured by analyzing therapy records and cost diaries. Data was gathered before, during, and after treatment, and at 6 and 12 months after treatment. Non-parametric bootstrap analyses were used to quantify the uncertainty concerning the cost-effectiveness ratio. In addition, cost-effectiveness planes and cost-effectiveness acceptability curves were performed. RESULTS: EXP showed a tendency to reduce disability, increase quality adjusted life years and decrease costs compared to GA. The incremental cost-effectiveness ratios of both the CEA and CUA are in favor of EXP. CONCLUSIONS: Based on these results, implementing EXP for this group of patients seems to be the best decision. TRIAL REGISTRATION: ISRCTN88087718.
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Four RCTs found some benefits of Exposure, including greater reduction in pain-related fear and perceived harmfulness of physical activity.
“These studies found some benefits of Exposure, including greater reduction in painrelated fear and perceived harmfulness of physical activity”
From Exposure and CBT for chronic back pain: An RCT on differential efficacy and optimal length of treatment (2018) · cites this paper as Goossens et al., 2015
The Background reports that exposure reduces pain-related fear and that one multicenter RCT found a greater reduction in perceived harmfulness of daily activities with exposure than with graded activity. Our copy does not establish that four RCTs found these benefits; its References also include non-RCT works among the studies cited for exposure’s effectiveness. No page numbers are available in the indexed copy. (LLM, conf=0.85)
Experimental — accuracy not yet measuredFour RCTs found no between-groups differences on the primary outcome, pain-related disability.
“but found no between-groups differences on the primary outcome, pain-related disability.”
From Exposure and CBT for chronic back pain: An RCT on differential efficacy and optimal length of treatment (2018) · cites this paper as Goossens et al., 2015
The Results > Outcomes section reports no statistically significant between-group difference in disability between exposure and graded activity. But Methods > Design and patients describes one randomized trial, conducted at four treatment centers—not four RCTs. This source supports the finding for one trial, not the stated count. (LLM, conf=0.87)
Experimental — accuracy not yet measuredPrevious studies suggested that delays in accessing workers' compensation and disability insurance may have impact on productivity outcomes among working age patients with chronic pain.
“Previous studies also suggested that delays in accessing workers' compensation and disability insurance may have impact on productivity outcomes among working age patients with chronic pain.15,45”
From Productivity outcomes from chronic pain management interventions in the working age population; a systematic review (2024) · cites this paper as [15]
The Methods (Cost measures) calculate productivity loss from work absenteeism, and the Discussion considers possible reasons for absenteeism. Neither section addresses delays in accessing workers’ compensation or disability insurance. Searches for those terms and for delayed access found no passage linking such delays to productivity outcomes; the indexed passages provide no page numbers. (LLM, conf=0.76)
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References 45 · Cited by 29
- Authors
- Goossens, M. E. J. B., de Kinderen, R. J. A., Leeuw, M., de Jong, J. R., Ruijgrok, J., Evers, S. M. A. A., & Vlaeyen, J. W. S.
- Affiliations
- Adelante (NL)
- Maastricht University Medical Centre (NL)
- Maastricht University (NL)
- Venue
- BMC Health Services Research
- Published
- 2015-06
- Volume
- 15
- Issue
- 1
- Pages
- 549-549
- ISSN
- 1472-6963 (ISSN-L)
- PMC
- PMC4677446
- OpenAlex
- W2189630694
- Cited by
- 29
- References
- 45
- Citations by year
- 2026: 3 · 2024: 4 · 2023: 1 · 2022: 3 · 2021: 3 · 2020: 2 · 2019: 4 · 2018: 5 · 2017: 2 · 2016: 2
- FWCI
- 2.16
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Health Services Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, cc-by)
- Lirias (acceptedVersion, other-oa)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Funders
- ZonMw
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
- Keywords
- chronic low back pain, graded activity, cognitive behavioral therapy, fear of pain, cost-effectiveness, cost-utility analysis, disability, quality-adjusted life years, health care utilization, non-specific back pain
- MeSH terms
- Adult, Cost-Benefit Analysis, Female, Persons with Disabilities, Health Status Indicators, Humans, Male, Middle Aged, Netherlands, Cognitive Behavioral Therapy, Low Back Pain, Quality-Adjusted Life Years, Chronic Pain
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