Journal of Occupational Rehabilitation

, Volume 7, Issue 1, pp 15–32 | Cite as

Economic evaluation of back pain interventions

  • Mariëlle E. J. B. Goossens
  • Silvia M. A. A. Evers


Despite the rising health care costs of back pain, the evaluation of economic aspects of back pain interventions has received little attention. This paper reviews 23 economic evaluation studies of back pain interventions looking at costs, consequences, and other methodological aspects. This paper gives a detailed summary of the economic evaluation data given by these studies and provides insight into the quality of economic evaluation in the field of back pain. Seven of the studies dealt with injury-prevention programs, six with post-incidence management programs, and ten studies with back injury and pain remedies. The injury prevention programs (except for back pain programs) and post-incidence management programs appear to produce cost savings due to reduced absenteeism. This paper shows that because of differences in the measurement of costs and outcomes and other methodological limitations, it is impossible to draw conclusions in favor of any one type of program.

Key Words

back pain outcomes research economic evaluation review cost effectiveness analysis cost utility analysis cost minimization analysis cost benefit analysis 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Frymoyer JW, Cats-Baril WL. An overview of the incidences and costs of low back pain.Orthop Clin North Am 1991; 22: 263–271.PubMedGoogle Scholar
  2. 2.
    Girolamo de G. Epidemiology and social costs of low back pain and fibromyalgia.Clin J Pain 1991; 7 (Suppl. 1): s1-s7.PubMedCrossRefGoogle Scholar
  3. 3.
    Andersson GBJ. The Epidemiology of Spinal Disorders. In: Frymoyer JW, ed.The adult spine: Principles and practice. New York: Raven Press, 1991, pp. 107–146.Google Scholar
  4. 4.
    Frymoyer JW. Back pain and sciatica.New Engl J Med 1988; 318(5): 291–299.PubMedCrossRefGoogle Scholar
  5. 5.
    Borenstein D. Epidemiology, etiology, diagnostic evaluation, and treatment of low back pain.Curr Opin Rheumatol 1992; 4(2): 226–232.PubMedCrossRefGoogle Scholar
  6. 6.
    Kelsey JL, Golden AL, Mundt DJ. Low back pain/prolapsed lumbar intervertebral disc.Rheum Dis Clin N Am 1990; 16(3): 699–711.Google Scholar
  7. 7.
    Akeson WH, Murphy RW. Low back pain.Clin Orthop 1977; 129(2).Google Scholar
  8. 8.
    Grazier KL, Holbrook TL, Kelsey JL,et al. The frequency of occurrence, impact, and cost of musculoskeletal conditions in the United States. Chicago: American Academy of Orthopaedic Surgeons, 1984.Google Scholar
  9. 9.
    Rice DP, Hodgson TA, Kopstein AN. The economic costs of illness: A replication and update.Health Care Financ Rev 1985; 7: 61–80.PubMedGoogle Scholar
  10. 10.
    Snook SH. The cost of back pain in industry.J Occup Med: State Art Rev 1988; 3(1): 1–5.Google Scholar
  11. 11.
    Cats-Baril WL, Frymoyer JW. The economics of spinal disorders. In:The adult spine. Principles and practice. New York: Raven Press, 1991.Google Scholar
  12. 12.
    Klaber Moffett J, Richardson G, Sheldon TA, Maynard A.Back pain. Its management and cost to society. The University of York, Centre for Health Economics, York Health Economics Consortium, NHS Centre for Reviews & Dissemination, 1995.Google Scholar
  13. 13.
    Jonsson E. Statens Beredning för Utvärdering av Medicinsk Metodik. The Swedish Council on Technology Assessment in Health Care, The Problem of Back Pain, Proceedings from a Conference, SBU, Sweden Stockholm, 1989.Google Scholar
  14. 14.
    Tulder van MW, Koes BW, Bouter LM. A cost-of-illness study of back pain in The Netherlands.Pain 1995; 62: 233–240.PubMedCrossRefGoogle Scholar
  15. 15.
    Spengler DM, Bigos SJ, Martin NA, Zeh J, Fisher L, Nachemson A. Back injuries in industry: A retrospective study. I. Overview and cost analysis.Spine 1986; 11(3): 241–245.PubMedCrossRefGoogle Scholar
  16. 16.
    Abenhaim L, Suissa S. Importance and economic burden of occupational back pain: A study of 2,500 cases representative of Quebec.J Occup Med 1987; 29(8): 670–674.PubMedGoogle Scholar
  17. 17.
    Snook SH, Webster BS. The cost of disability.Clin Orthop 1987; 221: 77–84.PubMedGoogle Scholar
  18. 18.
    Webster BS, Snook SH. The cost of compensable low back pain.J Occup Med 1990; 32(1): 13–15.PubMedCrossRefGoogle Scholar
  19. 19.
    Leavitt SS, Johnston TL, Robert DB. The process of recovery: Patterns in industrial back injury, part 1 costs and other quantitative measures of effort.Indust Med 1972; 40(8): 7–14.Google Scholar
  20. 20.
    Luce B, Elixhauser A. Estimating costs in the economic evaluation of medical technologies.Int J Technol Assess Health Care 1990; 6: 57–75.PubMedGoogle Scholar
  21. 21.
    Stieg RL, Williams RC, Timmermans-Williams G, Tafuro F, Gallagher LA. Cost benefits of interdisciplinary chronic pain treatment.Clin J Pain 1986; 1: 189–193.Google Scholar
  22. 22.
    Health Economics. Economic evaluation bibliography.Health Econ (Suppl.) 1992; 1.Google Scholar
  23. 23.
    Evers SMAA, Wijk van AS. Toolkit for Reviewing Literature. Working paper: 94-3. Department of Health Economics, University of Limburg, Maastricht, 1994.Google Scholar
  24. 24.
    Aarås A. The impact of ergonomic intervention on individual health and corporate prosperity in a telecommunications environment.Ergonomics 1994; 37(10): 1679–1696.PubMedGoogle Scholar
  25. 25.
    Brown KC, Sirles AT, Hilyer JC, Thomas MJ. Cost-effectiveness of a back school intervention for municipal employees.Spine 1992; 17(10): 1224–1228.PubMedCrossRefGoogle Scholar
  26. 26.
    Coleman S, Hansen S. Reducing work-related back injuries.Nurs Mgm 1994; 25(11): 58–61.Google Scholar
  27. 27.
    Hochanadel CD, Conrad DE. Evolution of an on-site industrial physical therapy program.JOM 1993; 35(10): 1011–1016.PubMedGoogle Scholar
  28. 28.
    Liang M, Komaroff AL. Roentgenograms in primary care patients with acute low back pain. A cost-effectiveness analysis.Arch Int Med 1982; 142: 1108–1112.CrossRefGoogle Scholar
  29. 29.
    Linton SJ, Bradley LA. An 18-month follow-up of a secondary prevention program for back pain: Help and hindrance factors related to outcome maintenance.Clin J Pain 1992; 8(3): 227–236.PubMedGoogle Scholar
  30. 30.
    Linton SJ, Hellsing AL, Andersson D. A controlled study of the effects of an early intervention on acute musculosketal pain problems.Pain 1993; 54: 353–359.PubMedCrossRefGoogle Scholar
  31. 31.
    MacLean DS. Family practice and the health care system. Outcome and cost of family physicians’ care. Pilot study of three diagnosis-related groups in elderly inpatients.J Am Board Fam Pract 1993; 6: 588–593.PubMedGoogle Scholar
  32. 32.
    Malmivaara A, Häkkinen U, Aro T, Heinrichs MJ, Koskenniemi L, Kuosma E, Lappi S, Paloheimo R, Servo C, Vaaranen V, Hernberg S. The treatment of acute low back pain-bed rest, exercises, or ordinary activity?N Engl J Med 1995; 332(6): 351–355.PubMedCrossRefGoogle Scholar
  33. 33.
    Meade TW, Dyer S, Browne W, Townsend J, Frank AO. Low back pain of mechanical origin: Randomized comparison of chiropractic and hospital outpatient treatment (see comments).BMJ 1990; 300(6737): 1431–1437.PubMedGoogle Scholar
  34. 34.
    Mitchell RI, Carmen GM. Results of a multicenter trial using an intensive active exercise program for the treatment of acute soft tissue and back injuries.Spine 1990; 15(6): 514–521.PubMedCrossRefGoogle Scholar
  35. 35.
    Mitchell LV, Lawler FH, Bowen D, Mote W, Asundi P, Purswell J. Effectiveness and cost-effectiveness of employer-issued back belts in areas of high risk for back injury.JOM 1994; 36(1): 90–94.PubMedGoogle Scholar
  36. 36.
    Mitchell RI, Carmen GM. The functional restoration approach to the treatment of chronic pain in patients with soft-tissue and back injuries.Spine 1994; 19(6): 633–642.PubMedCrossRefGoogle Scholar
  37. 37.
    Nyiendo J. Disabling low back Oregon workers’ compensation claims. Part III: Diagnostic and treatment procedures and associated costs.J Manip Physiol Ther 1991; 14(5): 287–297.Google Scholar
  38. 38.
    Ramirez LF, Javid MJ. Cost effectiveness of chemonucleolysis versus laminectomy in the treatment of herniated nucleus pulposus.Spine 1985; 10(4): 363–367.PubMedCrossRefGoogle Scholar
  39. 39.
    Ryan WE, Krishna MK, Swanson CE. A prospective study evaluating early rehabilitation in preventing back pain chronicity in mine workers.Spine 1995; 20(4): 489–491.PubMedGoogle Scholar
  40. 40.
    Ryden LA, Molgaard CA, Bobbitt SL. Benefits of a back care and light duty health promotion program in a hospital setting.J Commun Health 1988; 13(4): 222–230.CrossRefGoogle Scholar
  41. 41.
    Shekelle PG, Markovich M, Louie R. Comparing the costs between provider types of episodes of back pain care.Spine 1995; 20(2): 221–227.PubMedCrossRefGoogle Scholar
  42. 42.
    Simmons JW, Avant WS Jr, Demski J, Parisher D. Determining successful pain clinic treatment through validation of cost effectiveness,Spine 1988; 13(3): 342–344.PubMedCrossRefGoogle Scholar
  43. 43.
    Timm KE. A randomized-control study of active and passive treatments for chronic low back pain following L5 laminectomy.JOSPT 1994; 20(6): 276–286.PubMedGoogle Scholar
  44. 44.
    Versloot JM, Rozeman A, Son van AM, Akkerveeken van PF. The cost-effectiveness of a back school program in industry. A longitudinal controlled field study.Spine 1992; 17(1): 22–27.PubMedCrossRefGoogle Scholar
  45. 45.
    Wiesel SW, Boden SD, Feffer HL. A quality-based protocol for management of musculoskeletal injuries.Clin Orthop 1994; 301: 164–176.PubMedGoogle Scholar
  46. 46.
    Drummond MF, Stoddart GL, Torrance GW.Methods for the economic evaluation of health care programmes. New York: Oxford University Press, 1987.Google Scholar
  47. 47.
    Keijsers JFEM.The Efficacy of Back Schools: Empirical Evidence and Its Impact on Health Care Practice. Dissertation, Maastricht, 1991.Google Scholar
  48. 48.
    Rice DP, Kelman S, Miller LS, Dunmeyer S.The economic cost of alcohol and drug abuse and mental illness. Rockville: National Institute of Mental Health, DHHS pub. no. (ADM) 90-1694, 1990.Google Scholar
  49. 49.
    Finkler SA. The distinction between costs and charges.Ann Int Med 1982; 96: 102–109.PubMedGoogle Scholar
  50. 50.
    Hodgson T, Meiners M. Cost-of-illness methodology: A guide to current practices and procedures.Health Society 1982; 60(3).Google Scholar
  51. 51.
    Koopmanschap MA, Ineveld van BM. Towards a new approach for estimating indirect costs of disease.Soc Sci Med 1992; 34: 1005–1010.PubMedCrossRefGoogle Scholar
  52. 52.
    Eisenberg JM. Clinical Economics; A guide to the economic analysis of clinical practices.JAMA 1989; 262(20): 2879–2886.PubMedCrossRefGoogle Scholar
  53. 53.
    Fried BJ, Worthington C, Deber RB. Economic evaluations in the Canadian mental health, System I: Theory behind economic evaluation.Can J Psychiat 1989a; 34: 633–636.Google Scholar
  54. 54.
    Fried BJ, Worthington C, Deber RB. Economic evaluations in the Canadian mental health, System II: From theory to practice in mental health care.Can J Psychiat 1989b; 24: 637–640.Google Scholar
  55. 55.
    Gerard K. Cost-utility in practice: A policy maker’s guide to the state of the art.Health Pol 1992; 21: 249–279.CrossRefGoogle Scholar
  56. 56.
    Department of Clinical Epidemiology and Biostatistics, McMaster University Health Sciences Center. How to read clinical journals: VII. To understand an economic evaluation.Can Med Assoc J 1984; 130: 1428–1434, 1542–1549.Google Scholar
  57. 57.
    Spilker B.Quality of life assessment in clinical trials. New York: Raven Press, 1990.Google Scholar
  58. 58.
    Drummond MF.Principles of economic appraisals in health care. New York: Oxford University Press, 1980.Google Scholar
  59. 59.
    Linton SJ, Bradley LA, Jensen I, Spangfort E, Sundell L. The secondary prevention of low back pain: A controlled study with follow-up.Pain 1989; 36: 197–207.PubMedCrossRefGoogle Scholar
  60. 60.
    Drummond M, Brandt A, Luce B, Rovira J. Standardizing methodologies for economic evaluation in health care: Practice, problems and potential.Int J Technol Assess Health Care 1993; 9(1): 26–35.PubMedCrossRefGoogle Scholar
  61. 61.
    Kleijnen JMP, Knipschild P. Niacin and vitamin B6 in mental functioning: A Review of controlled-trials in humans.Biol Psychiat 1991; 29: 931–941.PubMedCrossRefGoogle Scholar
  62. 62.
    Goodman C. It’s time to rethink health care technology assessment.Int J Technol Assess Health Care 1992; 8(2): 335–358.PubMedCrossRefGoogle Scholar
  63. 63.
    Rutten-van Mölken MPMH, van Doorslaer EKA, Rutten FFH, Economic appraisal of asthma and COPD care: A literature review 1980–1991.Soc Sci Med 1992; 35(2): 161–175.CrossRefGoogle Scholar
  64. 64.
    Udvarhelyi S, Colditz GA, Rai A, Epstein A. Cost-effectiveness and cost-benefit analysis in the medical literature.Ann Int Med 1992; 116: 238–244.PubMedGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1997

Authors and Affiliations

  • Mariëlle E. J. B. Goossens
    • 1
    • 2
  • Silvia M. A. A. Evers
    • 1
    • 3
  1. 1.Department of Health EconomicsUniversity of MaastrichtMaastrichtThe Netherlands
  2. 2.Institute for Rehabilitation ResearchHoensbroekThe Netherlands
  3. 3.Department of NeurosurgeryUniversity Hospital of MaastrichtMaastrichtThe Netherlands

Personalised recommendations