Cost-minimisation analysis of three conservative treatment programmes in 180 patients sick-listed for acute low-back pain

Objective - To perform st cost-minimization analysis of three conservative treatment regimes for acute low-back pain (LBP). Design - A prospective randomized clinical trial. Patients were assigned at random to one of three treatment programmes: General Practitioner Programm e (GPP-) controls, ManuaI Therapy Programme (MTP) or Intensive Training Pro gramme (ITP). Setting - Primary care and physiotherapists in Stockholm, Sweden. Patients -180 patients sick-listed for acute LBP. Main outcome measures - Direct, indirect and total costs for three treatmen t programmes. Results - The direct costs for treatment were lowest in the GPP group -2744 Swedish crowns (SEK) per patient. More patients in the MTP and ITP underwe nt operations for disk hernia and radio- logical investigations than in the GPP. Indirect costs, defined as sick-leave for LBP represent about 90% of the total cost. Conclusions - With respect to total costs, the findings were similar betwee n the three treatment programmes. The GPP had the lowest direct costs. It i s not possible to conclude which treatment programme is to be recommended a s a least cost alternative. The strong effect of indirect costs an the tota l cost stresses that further studies should focus on methods of shortening sick-leave.