Researchers: Amir Shmueli¹, Daniel Deutscher², Maya Leventer-Roberts³

Background: Low back pain (LBP) is a major public health problem worldwide and has been estimated to cost 2% of the gross domestic product in developed countries. Studies have shown that there is overuse, exposure to excess radiation, and inappropriate care being provided by primary care physicians (PCPs). In 2007, Israeli LBP guidelines were disseminated with the aim of reducing inappropriate care and costs.

Objectives: To evaluate whether the introduction of the LBP guidelines in 2007 caused a change in the patterns and cost of LBP treatment in Israel.

Method: We compared the use of services and the cost of LBP care in the two leading Israeli health plans, before the dissemination (2006) and after (2009 and 2012).
Analysis of variance and regression models were used to estimate the effect of the change on use and cost.

Findings: Clalit: The mean utilization of x-rays rose from 0.079 in 2006 to 0.261 in 2009 and to 0.229 in 2012 (p<0.05). The mean number of anti-depressants purchased rose from 0.618 in 2006 to 0.695 in 2009, and to 0.741 in 2012 (p<0.05). The total mean LBP utilization cost per LBP patient rose when comparing both 2006 to 2009 and 2006 to 2012.
Maccabi: The mean utilization of x-rays decreased from 0.21 in 2006 to 0.18 in 2012 (p<0.05). The mean CT utilization rose from 0.009 in 2006 to 0.11 in 2012 (p<0.05). The mean number of anti-depressants purchased rose from 0.90 in 2006 to 1.06 in 2009, and to 1.24 in 2012 (p<0.05). The total mean LBP utilization cost per LBP patient rose when comparing both 2006 to 2009 and 2006 to 2012.

Conclusions: Our results show that PCPs continue to provide LBP treatments which are inconsistent with guidelines and thus inappropriate and not cost-effective.

Recommendations: Exploration of effective guideline implementation programs is required. Incentives to PCP might prove effective.

Research end date: 09/2019