LAUSR

Introduction: The high prevalence, disability, and work absenteeism associated with back pain make it the single most costly musculoskeletal health condition in developed countries. However, the majority of back pain has no identifiable pathological cause and resolves without surgery or imaging. This paradox suggests that we need to change how back pain is managed to reduce unnecessary burden to individuals and the healthcare system. This study evaluated the cost of a new model of early triage-based, interprofessional care for patients with back pain. Methods: We evaluated the outcomes and cost of implementing a provincial care pathway for early assessment of patients with back pain at three sites: (i) adjacent to an emergency department in a community hospital; (ii) co-located with an orthopedic surgeon's clinic in a hospital; and (iii) in a primary care network (PCN) with private practice physiotherapists and chiropractors. Time-driven activity-based costing (TDABC), in combination with discrete event simulation, was used to estimate costs. Results: Costs were significantly lower in the models that used hospital-based physiotherapists and in the PCN model that used private practice physiotherapists and chiropractors to triage patients. These costs ranged from CAD 20 (USD 16) to manage patients identified with low severity back pain to CAD 175 to 200 (USD 137 to 156) for those with moderate to severe back pain. Models that implemented the care pathway using family physicians and surgeons to review non-surgical patients were more expensive at CAD 339 (USD 265) and CAD 514 (USD 402), respectively. Conclusions: New models of care that use the skills of physiotherapists and chiropractors to assess and triage patients with back pain adjacent to emergency departments and in the primary care sector are cost effective, compared with traditional physician-led models. The overarching intent is to use these data to enable evidence-informed policy and practice changes, so that more appropriate and cost-effective care is provided to patients with back pain.