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Papers of the Week

Papers: 29 Aug 2020 - 4 Sep 2020

Human Studies

2020 Aug 27


The STarT Back stratified care model for non-specific low back pain: a model-based evaluation of long-term cost-effectiveness.


The STarT Back approach comprises subgrouping low back pain (LBP) patients according to risk of persistent LBP-related disability, with appropriate matched treatments. In a twelve-month clinical trial and implementation study, this stratified care approach was clinically and cost-effective compared to usual, non-stratified care. Despite the chronic nature of LBP and associated economic burden, model-based economic evaluations in LBP are rare and have shortcomings. This study therefore produces a de-novo decision model of this stratified care approach for LBP management to estimate the long-term cost-effectiveness and address methodological concerns in LBP modelling.A cost-utility analysis from the NHS perspective compared stratified care with usual care in patients consulting in primary care with non-specific LBP. A Markov state-transition model was constructed where patient prognosis over ten years was dependent upon physical function achieved at twelve months. Data from the clinical trial and implementation study provided short term model parameters, with extrapolation using two cohort studies of usual care in LBP.Base-case results indicate this model of stratified care is cost-effective, delivering 0.14 additional quality-adjusted life years (QALYs) at a cost-saving of £135.19 per patient over a time horizon of ten-years. Sensitivity analyses indicate the approach is likely to be cost-effective in all scenarios, and cost-saving in most.It is likely this stratified care model will help reduce unnecessary healthcare usage whilst improving patient quality of life. Whilst decision analytic modelling is employed in many conditions, its use has been underexplored in LBP and this paper also addresses associated methodological challenges.