Cost-Utility Analysis of a Chronic Back Pain Multidisciplinary Biopsychosocial Rehabilitation (MBR) compared to Standard Care for Privately Insured in Germany

Abstract

\n Introduction: Multidisciplinary biopsychosocial rehabilitation (MBR) is highly recommended to treat chronic lower back pain (CLBP). However, its economic benefit remains to be clearly demonstrated. Objective: To analyse the effect of a 12-month MBR with behaviour-change coaching and device-supported exercise on direct medical costs, sick leave and health-related quality of life (HRQOL) at 24 months. Methods: A cohort of privately insured in Germany was evaluated using administrative and trial data. After removing dissimilarities in characteristics between MBR and control via propensity score matching, treatment effects were calculated with a Difference-in-Difference approach.Results: The base-case analysis comprised 112 MBR participants and 111 members in the standard care group. With an incremental cost-effectiveness ratio (ICER) of €8,428 per quality-adjusted life year (QALY) gained, the intervention was classified as cost-effective. Economically unaccounted sick leave due to back pain (BP) in the last six months was reduced by 17.5 days (p = 0.001) in the MBR group. Development of HRQOL was positive for the MBR (0.046, p= 0.026). Subgroup analysis with major impaired participants demonstrated the possibility of a dominant intervention with an ICER of - €6,861 per QALY. Savings were driven by a reduction in BP specific costs by - €1,733 (p= 0.035). Difference in sick leave was 27 days (p = 0.006) in favour of the MBR group.Conclusion: This is the first cost-utility study with combined data from a private health insurer and a controlled trial to demonstrate that long term MBR is cost-effective in the treatment of CLBP. Subgroups with major impairment benefit more from the intervention than participants with minor impairment. MBR significantly reduces sick leave in all participants making it a profitable intervention from society’s point of view.