Effectiveness and cost-effectiveness of a multidisciplinary programme compared to usual care for people with low back pain in Belgium

Objectives To compare costs and return-to-work (RTW) outcomes among workers with low back pain (LBP) participating in the secondary prevention pathway of the Federal Agency for Occupational Risks (FEDRIS). Methods We conducted a retrospective cohort study (2014–2020) using six linked Belgian administrative databases. Employees aged 18–65 in ergonomically demanding occupations with 4–26 weeks of work disability were categorised into: (a) FEDRIS pathway (≤36 multidisciplinary-based rehabilitation (MBR) sessions with optional workplace intervention (WPI)); (b) standard MBR (≤36 sessions no FEDRIS sponsorship) or (c) usual care (UC). Outcomes included direct medical and non-medical costs and RTW. Analyses employed propensity score weighting, regression modelling, Cox proportional hazards models and bootstrapped cost-effectiveness estimation. Results Among 6119 workers (3000 A; 206 B; 2913 C), the FEDRIS pathway showed the highest mean post-intervention costs (€7374) and disability duration (~111 days), compared with standard MBR (€4792; ~65 days) and UC (€4803; ~80 days). Within the FEDRIS pathway, WPI was associated with a~17 day reduction in disability, whereas additional MBR sessions increased costs (+7.8%) without improving disability duration. Compared with standard MBR, the FEDRIS pathway and UC were associated with a higher risk of work disability relapse (HR=1.55, 95% CI 1.27 to 1.89; HR=1.49, 95% CI 1.22 to 1.81). Cost-effectiveness analyses favoured standard MBR (lower costs, higher sustainable RTW). Conclusions The FEDRIS pathway was associated with higher costs and longer disability compared with standard MBR and UC although the WPI yielded measurable benefits. The standard MBR demonstrated superior cost-effectiveness.