Skip to main content
NCBI home page
Occupational and Environmental Medicine logoLink to Occupational and Environmental Medicine
. 2002 Dec;59(12):807–815. doi: 10.1136/oem.59.12.807

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

P Loisel 1, J Lemaire 1, S Poitras 1, M Durand 1, F Champagne 1, S Stock 1, B Diallo 1, C Tremblay 1
PMCID: PMC1763600  PMID: 12468746

Abstract

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.

Full Text

The Full Text of this article is available as a PDF (262.6 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. 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 Aug;29(8):670–674. [PubMed] [Google Scholar]
  2. Cutler R. B., Fishbain D. A., Rosomoff H. L., Abdel-Moty E., Khalil T. M., Rosomoff R. S. Does nonsurgical pain center treatment of chronic pain return patients to work? A review and meta-analysis of the literature. Spine (Phila Pa 1976) 1994 Mar 15;19(6):643–652. doi: 10.1097/00007632-199403001-00002. [DOI] [PubMed] [Google Scholar]
  3. Durand Marie-José, Loisel Patrick. Therapeutic Return to Work: Rehabilitation in the workplace. Work. 2001;17(1):57–63. [PubMed] [Google Scholar]
  4. Elders L. A., van der Beek A. J., Burdorf A. Return to work after sickness absence due to back disorders--a systematic review on intervention strategies. Int Arch Occup Environ Health. 2000 Jul;73(5):339–348. doi: 10.1007/s004200000127. [DOI] [PubMed] [Google Scholar]
  5. Federspiel C. F., Guy D., Kane D., Spengler D. Expenditures for nonspecific back injuries in the workplace. J Occup Med. 1989 Nov;31(11):919–924. doi: 10.1097/00043764-198911000-00015. [DOI] [PubMed] [Google Scholar]
  6. Flor H., Fydrich T., Turk D. C. Efficacy of multidisciplinary pain treatment centers: a meta-analytic review. Pain. 1992 May;49(2):221–230. doi: 10.1016/0304-3959(92)90145-2. [DOI] [PubMed] [Google Scholar]
  7. Frank J. W., Brooker A. S., DeMaio S. E., Kerr M. S., Maetzel A., Shannon H. S., Sullivan T. J., Norman R. W., Wells R. P. Disability resulting from occupational low back pain. Part II: What do we know about secondary prevention? A review of the scientific evidence on prevention after disability begins. Spine (Phila Pa 1976) 1996 Dec 15;21(24):2918–2929. doi: 10.1097/00007632-199612150-00025. [DOI] [PubMed] [Google Scholar]
  8. Frank J., Sinclair S., Hogg-Johnson S., Shannon H., Bombardier C., Beaton D., Cole D. Preventing disability from work-related low-back pain. New evidence gives new hope--if we can just get all the players onside. CMAJ. 1998 Jun 16;158(12):1625–1631. [PMC free article] [PubMed] [Google Scholar]
  9. Frymoyer J. W., Cats-Baril W. L. An overview of the incidences and costs of low back pain. Orthop Clin North Am. 1991 Apr;22(2):263–271. [PubMed] [Google Scholar]
  10. Frymoyer J. W., Cats-Baril W. Predictors of low back pain disability. Clin Orthop Relat Res. 1987 Aug;(221):89–98. [PubMed] [Google Scholar]
  11. Hashemi L., Webster B. S., Clancy E. A. Trends in disability duration and cost of workers' compensation low back pain claims (1988-1996). J Occup Environ Med. 1998 Dec;40(12):1110–1119. doi: 10.1097/00043764-199812000-00011. [DOI] [PubMed] [Google Scholar]
  12. Lindström I., Ohlund C., Eek C., Wallin L., Peterson L. E., Fordyce W. E., Nachemson A. L. The effect of graded activity on patients with subacute low back pain: a randomized prospective clinical study with an operant-conditioning behavioral approach. Phys Ther. 1992 Apr;72(4):279–293. doi: 10.1093/ptj/72.4.279. [DOI] [PubMed] [Google Scholar]
  13. Linton S. J. The socioeconomic impact of chronic back pain: is anyone benefiting? Pain. 1998 Apr;75(2-3):163–168. doi: 10.1016/s0304-3959(97)00222-4. [DOI] [PubMed] [Google Scholar]
  14. Loisel P., Abenhaim L., Durand P., Esdaile J. M., Suissa S., Gosselin L., Simard R., Turcotte J., Lemaire J. A population-based, randomized clinical trial on back pain management. Spine (Phila Pa 1976) 1997 Dec 15;22(24):2911–2918. doi: 10.1097/00007632-199712150-00014. [DOI] [PubMed] [Google Scholar]
  15. Loisel P., Durand P., Abenhaim L., Gosselin L., Simard R., Turcotte J., Esdaile J. M. Management of occupational back pain: the Sherbrooke model. Results of a pilot and feasibility study. Occup Environ Med. 1994 Sep;51(9):597–602. doi: 10.1136/oem.51.9.597. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Loisel P., Gosselin L., Durand P., Lemaire J., Poitras S., Abenhaim L. Implementation of a participatory ergonomics program in the rehabilitation of workers suffering from subacute back pain. Appl Ergon. 2001 Feb;32(1):53–60. doi: 10.1016/s0003-6870(00)00038-7. [DOI] [PubMed] [Google Scholar]
  17. Mitchell C. S. Outcome studies in industry: cost-effectiveness of cumulative trauma disorder prevention. Am J Ind Med. 1996 Jun;29(6):689–696. doi: 10.1002/(SICI)1097-0274(199606)29:6<689::AID-AJIM13>3.0.CO;2-W. [DOI] [PubMed] [Google Scholar]
  18. Nachemson A. L. Newest knowledge of low back pain. A critical look. Clin Orthop Relat Res. 1992 Jun;(279):8–20. [PubMed] [Google Scholar]
  19. Scientific approach to the assessment and management of activity-related spinal disorders. A monograph for clinicians. Report of the Quebec Task Force on Spinal Disorders. Spine (Phila Pa 1976) 1987 Sep;12(7 Suppl):S1–59. [PubMed] [Google Scholar]
  20. Solomon D. H., Bates D. W., Panush R. S., Katz J. N. Costs, outcomes, and patient satisfaction by provider type for patients with rheumatic and musculoskeletal conditions: a critical review of the literature and proposed methodologic standards. Ann Intern Med. 1997 Jul 1;127(1):52–60. doi: 10.7326/0003-4819-127-1-199707010-00009. [DOI] [PubMed] [Google Scholar]
  21. Spitzer W. O. Low back pain in the workplace: attainable benefits not attained. Br J Ind Med. 1993 May;50(5):385–388. doi: 10.1136/oem.50.5.385. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Valat J. P., Goupille P., Védere V. Low back pain: risk factors for chronicity. Rev Rhum Engl Ed. 1997 Mar;64(3):189–194. [PubMed] [Google Scholar]
  23. Waddell G. 1987 Volvo award in clinical sciences. A new clinical model for the treatment of low-back pain. Spine (Phila Pa 1976) 1987 Sep;12(7):632–644. doi: 10.1097/00007632-198709000-00002. [DOI] [PubMed] [Google Scholar]
  24. Webster B. S., Snook S. H. The cost of 1989 workers' compensation low back pain claims. Spine (Phila Pa 1976) 1994 May 15;19(10):1111–1116. doi: 10.1097/00007632-199405001-00001. [DOI] [PubMed] [Google Scholar]
  25. Williams D. A., Feuerstein M., Durbin D., Pezzullo J. Health care and indemnity costs across the natural history of disability in occupational low back pain. Spine (Phila Pa 1976) 1998 Nov 1;23(21):2329–2336. doi: 10.1097/00007632-199811010-00016. [DOI] [PubMed] [Google Scholar]
  26. Yassi A., Tate R., Cooper J. E., Snow C., Vallentyne S., Khokhar J. B. Early intervention for back-injured nurses at a large Canadian tertiary care hospital: an evaluation of the effectiveness and cost benefits of a two-year pilot project. Occup Med (Lond) 1995 Aug;45(4):209–214. doi: 10.1093/occmed/45.4.209. [DOI] [PubMed] [Google Scholar]

Articles from Occupational and Environmental Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES