Evidence map›Paper›PMID 30870015›Full record

Observational studyJournal of alternative and complementary medicine (New York, N.Y.)2019

Cost-Effectiveness of a Team-Based Integrative Medicine Approach to the Treatment of Back Pain.

Peter M Wayne, Julie E Buring, David M Eisenberg, Kamila Osypiuk, Brian J Gow, Roger B Davis, Claudia M Witt, Thomas Reinhold

Open access · bronzeAbstract readObservational Study
In one paragraph

Observational study in Journal of alternative and complementary medicine (New York, N.Y.), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 2 pooled it
1.5field-weighted citation impact, top 19% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 2 syntheses or guidelines pooled it, 18 citations in OpenAlex.

  1. Pooled it
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  3. Trial
  4. Article
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  9. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 4 institutions in 3 countries.

Peter M Wayne1 Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA.
Julie E Buring1 Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA.
David M Eisenberg3 Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.
Kamila Osypiuk1 Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA.
Brian J Gow1 Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA.
Roger B Davis4 Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Claudia M Witt5 Institute for Complementary and Integrative Medicine, University Hospital Zurich, University of Zurich, Zürich, Switzerland.
Thomas Reinhold6 Institute of Social Medicine, Epidemiology, and Health Economics, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Berlin Institute of Health, Berlin, Germany.
Brigham and Women's Hospital · USHarvard University · USHumboldt-Universität zu Berlin · DEUniversity Hospital of Zurich · CH

Funding

Use and Effectiveness of a Model Integrative Care Clinic in an Academic HospitalR01AT005065 · NCCIH · BRIGHAM AND WOMEN'S HOSPITAL · PI BURING, JULIE E., WAYNE, PETER MICHAEL · 2010 to 2014
$3.1M
Mentoring and research in mind-body and integrative therapiesK24AT009282 · NCCIH · BRIGHAM AND WOMEN'S HOSPITAL · PI WAYNE, PETER MICHAEL · 2017 to 2021
$834k
NCCIH NIH HHS K24 AT009282NCCIH NIH HHS R01 AT005065
6 · The paper itself

Abstract

objectivesTo report the results of health economic analyses comparing two treatment approaches for chronic low back pain (CLBP).

designObservational prospective cohort study comparing effectiveness and cost-effectiveness of CLBP care provided at an integrative care clinic with that provided in other clinics within the same hospital. CLBP-related medical utilization, function, quality of life, and days of work incapacity were self-reported at baseline, 3, 6, and 12 months. SETTINGS/LOCATION: Osher Clinical Center (OCC) based at a tertiary academic hospital (Brigham and Women's Hospital [BWH]) and other clinics at BWH. SUBJECTS: CLBP patients seeking care at OCC or non-OCC BWH clinics.

interventionsIntegrative or conventional care for CLBP as prescribed by the treating clinician(s). OUTCOME MEASURES: Quality-adjusted life years (QALYs) were estimated per treatment approach based on the SF-12. Cost per QALY gained was evaluated using an incremental cost-effectiveness ratio (ICER). ICERs based on CLBP-specific effectiveness measures (Roland Disability Questionnaire [RDQ] and bothersomeness of pain [BOP]) were exploratory outcomes.

resultsTotal adjusted annual CLBP-related costs per patient were greater in the OCC versus non-OCC group ($11,526.73 vs. $6,810.63). Between group differences in QALYs were small and ICER estimate of cost per QALY gained was high ($436,676). However, unadjusted mean direct costs per patient decreased over time in the OCC group. Savings in direct costs of $391 (95% confidence interval: -1,078 to 1,861) were observed in the OCC group for the 6- to 12-month period, driven primarily by reduced medication usage. ICERs based on adjusted RDQ and BOP group differences showed cost of $2,073 and $4,203 for a one-point reduction per respective scale.

conclusionsWhen adjusted for baseline differences, self-reported costs were higher in the OCC group with only small effects on QALYs. However, trends toward decreased direct expenditures and medication usage over time warrant further investigation. Future studies evaluating potential benefits of integrative care models for the management of CLBP should employ randomized designs, longer observational periods, and explore multiple metrics of cost-effectiveness.

Indexed as

Integrative MedicineAdultAgedBack PainChronic PainComplementary TherapiesCost-Benefit AnalysisFemaleHumansMaleMiddle AgedProspective StudiesQuality-Adjusted Life YearsTreatment Outcomechronic low back paincost-effectivenessintegrative medicineinterdisciplinary care

Identifiers

PMID30870015
PMCPMC6444892
OpenAlexW2921905717

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.