ORIGINAL ARTICLE

Cost-benefit and cost-effectiveness analysis of a disability prevention model for back pain management: a six year follow up study

P Loisel¹, J Lemaire², S Poitras³, M-J Durand⁴, F Champagne⁵, S Stock⁶, B Diallo⁷ and C Tremblay⁸

¹ Department of Surgery (Division of Orthopedics), Université de Sherbrooke and Centre de recherche clinique en réadaptation au travail PREVICAP, Hôpital Charles LeMoyne, 1111, rue St-Charles Ouest, bureau 101, Longueuil, Québec, Canada, J4K 5G4
² Centre de recherche, Hôpital Charles LeMoyne, 3120 Taschereau Blvd, Greenfield Park, Québec, Canada, J4V 2H1
³ Centre de recherche clinique en réadaptation au travail PREVICAP, Hôpital Charles LeMoyne
⁴ Department of Community Health Centre, Université de Sherbrooke and Centre de recherche clinique en réadaptation au travail PREVICAP, Hôpital Charles LeMoyne
⁵ GRIS/Faculté de médecine, Université de Montréal, C.P. 6128, succ. Centre-ville, Montréal, Québec, Canada, H3C 3J7
⁶ Occupational and Environmental Health Unit, Montreal Department of Public Health, 1301, Sherbrooke Est Street, Montréal, Québec, Canada, H2L 1M3
⁷ Centre de recherche clinique en réadaptation au travail PREVICAP, Hôpital Charles LeMoyne
⁸ DSPPÉ Montérégie, 5245, Cousineau Blvd, room 3000, Saint-Hubert, Québec, Canada, J3Y 6J8

Correspondence to:
Correspondence to:
Dr P Loisel, Centre de recherche clinique en réadaptation au travail PREVICAP, Hôpital Charles LeMoyne, 1111, rue St-Charles Ouest, bureau 101, Longueuil, Québec, Canada, J4K 5G4;
patrick.loisel{at}usherbrooke.ca

Aims: To test the long term cost-benefit and cost-effectiveness of the Sherbrooke model of management of subacute occupational back pain, combining an occupational and a clinical rehabilitation intervention.

Methods: A randomised trial design with four arms was used: standard care, occupational arm, clinical arm, and Sherbrooke model arm (combined occupational and clinical interventions). From the Quebec WCB perspective, a cost-benefit (amount of consequence of disease costs saved) and cost-effectiveness analysis (amount of dollars spent for each saved day on full benefits) were calculated for each experimental arm of the study, compared to standard care.

Results: At the mean follow up of 6.4 years, all experimental study arms showed a trend towards cost benefit and cost effectiveness. These results were owing to a small number of very costly cases. The largest number of days saved from benefits was in the Sherbrooke model arm.

Conclusions: A fully integrated disability prevention model for occupational back pain appeared to be cost beneficial for the workers’ compensation board and to save more days on benefits than usual care or partial interventions. A limited number of cases were responsible for most of the long term disability costs, in accordance with occupational back pain epidemiology. However, further studies with larger samples will be necessary to confirm these results.

Keywords: low back pain; cost; randomised clinical trial

Abbreviations: AIC, additional intervention costs; ATC, additional total costs; CB, cost-benefit; CE, cost-effectiveness; CSST, single workers’ compensation board; DFB, days on full benefit; GDP, gross domestic product; OECD, Organisation for Economic Cooperation and Development; SCDC, saved consequence of disease costs; SDFB, saved days on full benefits; WCB, Workers Compensation Board

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