Factors associated with costs and health outcomes in patients with Back and leg pain in primary care: a prospective cohort analysis

Jesse Kigozi; Kika Konstantinou; Reuben Ogollah; Kate Dunn; Lewis Martyn; Susan Jowett

doi:10.1186/s12913-019-4257-0

Factors associated with costs and health outcomes in patients with Back and leg pain in primary care: a prospective cohort analysis

BMC Health Serv Res. 2019 Jun 21;19(1):406. doi: 10.1186/s12913-019-4257-0.

Authors

Jesse Kigozi^{1

2}, Kika Konstantinou³, Reuben Ogollah⁴, Kate Dunn³, Lewis Martyn^{3

5}, Susan Jowett^{6

3}

Affiliations

¹ Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. j.kigozi@bham.ac.uk.
² Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, Staffordshire, UK. j.kigozi@bham.ac.uk.
³ Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, Staffordshire, UK.
⁴ Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK.
⁵ Keele Clinical Trials Unit, David Weatherall Building, Keele University, Keele, Staffordshire, ST5 5BG, UK.
⁶ Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.

Abstract

Background: There is limited research on the economic burden of low back-related leg pain, including sciatica. The aim of this study was to describe healthcare resource utilisation and factors associated with cost and health outcomes in primary care patients consulting with symptoms of low back-related leg pain including sciatica.

Methods: This study is a prospective cohort of 609 adults visiting their family doctor with low back-related leg pain, with or without sciatica in a United Kingdom (UK) Setting. Participants completed questionnaires, underwent clinical assessments, received an MRI scan, and were followed-up for 12-months. The economic analysis outcome was the quality-adjusted life year (QALY) calculated from the EQ-5D-3 L data obtained at baseline, 4 and 12-months. Costs were measured based on patient self-reported information on resource use due to back-related leg pain and results are presented from a UK National Health Service (NHS) and Societal perspective. Factors associated with costs and outcomes were obtained using a generalised linear model.

Results: Base-case results showed improved health outcomes over 12-months for the whole cohort and slightly higher QALYs for patients in the sciatica group. NHS resource use was highest for physiotherapy and GP visits, and work-related productivity loss highest from a societal perspective. The sciatica group was associated with significantly higher work-related productivity costs. Cost was significantly associated with factors such as self-rated general health and care received as part of the study, while quality of life was significantly predicted by self-rated general health, and pain intensity, depression, and disability scores.

Conclusions: Our results contribute to understanding the economics of low back- related leg pain and sciatica and may provide guidance for future actions on cost reduction and health care improvement strategies.

Trial registration: 13/09/2011 Retrospectively registered; ISRCTN62880786 .

Keywords: And sciatica; Back pain; Cost; Leg pain; Outcome.

MeSH terms

Adult
Female
Health Care Costs / statistics & numerical data*
Humans
Leg / pathology*
Low Back Pain / complications
Low Back Pain / economics*
Low Back Pain / therapy
Male
Middle Aged
Pain / economics*
Pain / etiology
Pain Management
Primary Health Care / economics*
Prospective Studies
Quality-Adjusted Life Years
Sciatica / economics*
Sciatica / etiology
Sciatica / therapy
Treatment Outcome
United Kingdom

Abstract

MeSH terms

Grants and funding