{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T21:17:46Z","timestamp":1794345466194,"version":"4.9.0"},"reference-count":45,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2024,9,5]],"date-time":"2024-09-05T00:00:00Z","timestamp":1725494400000},"content-version":"unspecified","delay-in-days":4,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000780","name":"European Union","doi-asserted-by":"crossref","award":["689043"],"award-info":[{"award-number":["689043"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Danish Chiropractic Foundation","award":["A4526"],"award-info":[{"award-number":["A4526"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,8,9]]},"published-print":{"date-parts":[[2024,9]]},"abstract":"\n Objectives<\/jats:title>\n This study aims to investigate the cost-effectiveness of individually tailored self-management support, delivered via the artificial intelligence-based selfBACK app, as an add-on to usual care for people with low back pain (LBP).<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Secondary health-economic analysis of the selfBACK randomised controlled trial (RCT) with a 9-month follow-up conducted from a Danish national healthcare perspective (primary scenario) and a societal perspective limited to long-term productivity in the form of long-term absenteeism (secondary scenario).<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Primary care and an outpatient spine clinic in Denmark.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n A subset of Danish participants in the selfBACK RCT, including 297 adults with LBP randomised to the intervention (n=148) or the control group (n=149).<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n App-delivered evidence-based, individually tailored self-management support as an add-on to usual care compared with usual care alone among people with LBP.<\/jats:p>\n <\/jats:sec>\n \n Outcome measures<\/jats:title>\n Costs of healthcare usage and productivity loss, quality-adjusted life-years (QALYs) based on the EuroQol-5L Dimension Questionnaire, meaningful changes in LBP-related disability measured by the Roland-Morris Disability Questionnaire (RMDQ) and the Pain Self-Efficacy Questionnaire (PSEQ), costs (healthcare and productivity loss measured in Euro) and incremental cost-effectiveness ratios (ICERs).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The incremental costs were higher for the selfBACK intervention (mean difference \u20ac230 (95% CI \u2212136 to 595)), where ICERs showed an increase in costs of \u20ac7336 per QALY gained in the intervention group, and \u20ac1302 and \u20ac1634 for an additional person with minimal important change on the PSEQ and RMDQ score, respectively. At a cost-effectiveness threshold value of \u20ac23250, the selfBACK intervention has a 98% probability of being cost-effective. Analysis of productivity loss was very sensitive, which creates uncertainty about the results from a societal perspective limited to long-term productivity.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n From a healthcare perspective, the selfBACK intervention is likely to represent a cost-effective treatment for people with LBP. However, including productivity loss introduces uncertainty to the results.<\/jats:p>\n <\/jats:sec>\n \n Trial registration number<\/jats:title>\n \n NCT03798288<\/jats:ext-link>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-086800","type":"journal-article","created":{"date-parts":[[2024,9,6]],"date-time":"2024-09-06T02:36:19Z","timestamp":1725590179000},"page":"e086800","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Cost-effectiveness analysis of app-delivered self-management support (selfBACK) in addition to usual care for people with low back pain in Denmark"],"prefix":"10.1136","volume":"14","clinical-trial-number":[{"clinical-trial-number":"nct03798288","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct03798288","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Line Planck","family":"Kongstad","sequence":"first","affiliation":[{"name":"Department of Public Health, DaCHE - Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4395-8265","authenticated-orcid":false,"given":"Cecilie Krage","family":"\u00d8ver\u00e5s","sequence":"additional","affiliation":[{"name":"Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway"},{"name":"The Norwegian Chiropractors' Research Foundation - Et Liv i Bevegelse (ELiB), Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2064-9942","authenticated-orcid":false,"given":"Christian Volmar","family":"Skovsgaard","sequence":"additional","affiliation":[{"name":"Department of Public Health, DaCHE - Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8436-1046","authenticated-orcid":false,"given":"Louise Fleng","family":"Sandal","sequence":"additional","affiliation":[{"name":"Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5876-7410","authenticated-orcid":false,"given":"Jan","family":"Hartvigsen","sequence":"additional","affiliation":[{"name":"Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark"},{"name":"Chiropractic Knowledge Hub, University of Southern Denmark, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3968-6364","authenticated-orcid":false,"given":"Karen","family":"S\u00f8gaard","sequence":"additional","affiliation":[{"name":"Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark"},{"name":"Department of Clinical Research, University of Southern Denmark, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3355-2680","authenticated-orcid":false,"given":"Paul Jarle","family":"Mork","sequence":"additional","affiliation":[{"name":"Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0297-8267","authenticated-orcid":false,"given":"Mette Jensen","family":"Stochkendahl","sequence":"additional","affiliation":[{"name":"Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark"},{"name":"Chiropractic Knowledge Hub, University of Southern Denmark, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,9,5]]},"reference":[{"key":"2025121513045756000_14.9.e086800.1","doi-asserted-by":"crossref","DOI":"10.1186\/s13561-019-0239-5","article-title":"The medium, the message and the measure: a theory-driven review on the value of telehealth as a patient-facing digital health innovation","volume":"9","author":"Abimbola","year":"2019","journal-title":"Health Econ Rev"},{"key":"2025121513045756000_14.9.e086800.2","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1093\/abm\/kaad041","article-title":"Effective Behavior Change Techniques in Digital Health Interventions for the Prevention or Management of Noncommunicable Diseases: An Umbrella Review","volume":"57","author":"Mair","year":"2023","journal-title":"Ann Behav Med"},{"key":"2025121513045756000_14.9.e086800.3","unstructured":"Strategi for digital sundhed - sundhedsdatastyrelsen. Available: https:\/\/sundhedsdatastyrelsen.dk\/da\/strategier-og-projekter\/strategi-for-digital-sundhed [Accessed 19 Dec 2022]."},{"key":"2025121513045756000_14.9.e086800.4","doi-asserted-by":"crossref","unstructured":"Taylor SJ , Pinnock H , Epiphaniou E , et al . A Rapid Synthesis of the Evidence on Interventions Supporting Self-Management for People with Long-Term Conditions: PRISMS \u2013 Practical Systematic Review of Self-Management Support for Long-Term Conditions. Southampton (UK): NIHR Journals Library, 2014.","DOI":"10.3310\/hsdr02530"},{"key":"2025121513045756000_14.9.e086800.5","unstructured":"WHO . WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings. Available: https:\/\/www.who.int\/publications-detail-redirect\/9789240081789 [Accessed 23 Dec 2023]."},{"key":"2025121513045756000_14.9.e086800.6","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-017-5099-2"},{"key":"2025121513045756000_14.9.e086800.7","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1016\/j.bjpt.2021.05.002","article-title":"Self-management at the core of back pain care: 10 key points for clinicians","volume":"25","author":"Kongsted","year":"2021","journal-title":"Braz J Phys Ther"},{"key":"2025121513045756000_14.9.e086800.8","doi-asserted-by":"publisher","DOI":"10.1016\/S2665-9913(23)00098-X"},{"key":"2025121513045756000_14.9.e086800.9","doi-asserted-by":"crossref","first-page":"103507","DOI":"10.1016\/j.ijnurstu.2019.103507","article-title":"The efficacy of e-health in the self-management of chronic low back pain: A meta analysis","volume":"106","author":"Du","year":"2020","journal-title":"Int J Nurs Stud"},{"key":"2025121513045756000_14.9.e086800.10","doi-asserted-by":"crossref","DOI":"10.2196\/37869","article-title":"Digital Health Interventions for Musculoskeletal Pain Conditions: Systematic Review and Meta-analysis of Randomized Controlled Trials","volume":"24","author":"Valentijn","year":"2022","journal-title":"J Med Internet Res"},{"key":"2025121513045756000_14.9.e086800.11","doi-asserted-by":"crossref","DOI":"10.2196\/41113","article-title":"Economic Evaluations of Digital Health Interventions for the Management of Musculoskeletal Disorders: Systematic Review and Meta-Analysis","volume":"25","author":"Fatoye","year":"2023","journal-title":"J Med Internet Res"},{"key":"2025121513045756000_14.9.e086800.12","unstructured":"NICE . Project documents | Digital technologies for managing non-specific low back pain: early value assessment | Guidance | NICE, 2023. Available: https:\/\/www.nice.org.uk\/guidance\/indevelopment\/gid-hte10021\/documents [Accessed 18 Dec 2023]."},{"key":"2025121513045756000_14.9.e086800.13","doi-asserted-by":"crossref","DOI":"10.2196\/14720","article-title":"An App-Delivered Self-Management Program for People With Low Back Pain: Protocol for the selfBACK Randomized Controlled Trial","volume":"8","author":"Sandal","year":"2019","journal-title":"JMIR Res Protoc"},{"key":"2025121513045756000_14.9.e086800.14","doi-asserted-by":"crossref","DOI":"10.2196\/resprot.9379","article-title":"A Decision Support System to Enhance Self-Management of Low Back Pain: Protocol for the selfBACK Project","volume":"7","author":"Mork","year":"2018","journal-title":"JMIR Res Protoc"},{"key":"2025121513045756000_14.9.e086800.15","doi-asserted-by":"publisher","DOI":"10.1002\/ejp.1679"},{"key":"2025121513045756000_14.9.e086800.16","doi-asserted-by":"crossref","first-page":"1288","DOI":"10.1001\/jamainternmed.2021.4097","article-title":"Effectiveness of App-Delivered, Tailored Self-management Support for Adults With Lower Back Pain-Related Disability: A selfBACK Randomized Clinical Trial","volume":"181","author":"Sandal","year":"2021","journal-title":"JAMA Intern Med"},{"key":"2025121513045756000_14.9.e086800.17","doi-asserted-by":"crossref","DOI":"10.1186\/s12916-022-02237-z","article-title":"Multimorbidity and co-occurring musculoskeletal pain do not modify the effect of the SELFBACK app on low back pain-related disability","volume":"20","author":"\u00d8ver\u00e5s","year":"2022","journal-title":"BMC Med"},{"key":"2025121513045756000_14.9.e086800.18","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pdig.0000302","article-title":"Do age, gender, and education modify the effectiveness of app-delivered and tailored self-management support among adults with low back pain?-Secondary analysis of the selfBACK randomised controlled trial","volume":"2","author":"Bardal","year":"2023","journal-title":"PLOS Digit Health"},{"key":"2025121513045756000_14.9.e086800.19","doi-asserted-by":"crossref","DOI":"10.2196\/40422","article-title":"The Role of Pain Duration and Pain Intensity on the Effectiveness of App-Delivered Self-Management for Low Back Pain (selfBACK): Secondary Analysis of a Randomized Controlled Trial","volume":"11","author":"Nordstoga","year":"2023","journal-title":"JMIR Mhealth Uhealth"},{"key":"2025121513045756000_14.9.e086800.20","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1002\/ejp.2080","article-title":"The selfBACK artificial intelligence-based smartphone app can improve low back pain outcome even in patients with high levels of depression or stress","volume":"27","author":"Rughani","year":"2023","journal-title":"Eur J Pain"},{"key":"2025121513045756000_14.9.e086800.21","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.jval.2015.02.001","article-title":"Cost-effectiveness analysis alongside clinical trials II-An ISPOR Good Research Practices Task Force report","volume":"18","author":"Ramsey","year":"2015","journal-title":"Val Health"},{"key":"2025121513045756000_14.9.e086800.22","doi-asserted-by":"crossref","DOI":"10.1186\/s12916-021-02204-0","article-title":"Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations","volume":"20","author":"Husereau","year":"2022","journal-title":"BMC Med"},{"key":"2025121513045756000_14.9.e086800.23","doi-asserted-by":"crossref","DOI":"10.2196\/26555","article-title":"Using Intervention Mapping to Develop a Decision Support System-Based Smartphone App (selfBACK) to Support Self-management of Nonspecific Low Back Pain: Development and Usability Study","volume":"24","author":"Svendsen","year":"2022","journal-title":"J Med Internet Res"},{"key":"2025121513045756000_14.9.e086800.24","doi-asserted-by":"publisher","DOI":"10.1177\/1403494810394718"},{"key":"2025121513045756000_14.9.e086800.25","doi-asserted-by":"publisher","DOI":"10.1177\/1403494811401482"},{"key":"2025121513045756000_14.9.e086800.26","doi-asserted-by":"publisher","DOI":"10.1177\/1403494810394717"},{"key":"2025121513045756000_14.9.e086800.27","doi-asserted-by":"publisher","DOI":"10.1080\/14034940701271882"},{"key":"2025121513045756000_14.9.e086800.28","doi-asserted-by":"publisher","DOI":"10.1007\/s40258-021-00639-3"},{"key":"2025121513045756000_14.9.e086800.29","doi-asserted-by":"crossref","first-page":"3115","DOI":"10.1097\/00007632-200012150-00006","article-title":"The Roland-Morris Disability Questionnaire and the Oswestry Disability Questionnaire","volume":"25","author":"Roland","year":"2000","journal-title":"Spine (Phila Pa 1976)"},{"key":"2025121513045756000_14.9.e086800.30","doi-asserted-by":"crossref","DOI":"10.1097\/PR9.0000000000000972","article-title":"Measurement properties of the Pain Self-Efficacy Questionnaire in populations with musculoskeletal disorders: a systematic review","volume":"6","author":"Dub\u00e9","year":"2021","journal-title":"Pain Rep"},{"key":"2025121513045756000_14.9.e086800.31","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejpain.2005.12.008"},{"key":"2025121513045756000_14.9.e086800.32","unstructured":"Rubin D . Multiple imputation for nonresponse in surveys | bibsonomy. 1987. Available: https:\/\/www.bibsonomy.org\/bibtex\/20a72dbca78fbd5bc8ba192f31f5d5f2f\/jwbowers [Accessed 18 Dec 2023]."},{"key":"2025121513045756000_14.9.e086800.33","doi-asserted-by":"publisher","DOI":"10.1002\/hec.944"},{"key":"2025121513045756000_14.9.e086800.34","doi-asserted-by":"publisher","DOI":"10.1089\/tmj.2014.0053"},{"key":"2025121513045756000_14.9.e086800.35","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0170581","article-title":"What is the economic evidence for mHealth? A systematic review of economic evaluations of mHealth solutions","volume":"12","author":"Iribarren","year":"2017","journal-title":"PLOS ONE"},{"key":"2025121513045756000_14.9.e086800.36","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2022.787135","article-title":"The cost-effectiveness of digital health interventions: A systematic review of the literature","volume":"10","author":"Gentili","year":"2022","journal-title":"Front Public Health"},{"key":"2025121513045756000_14.9.e086800.37","doi-asserted-by":"crossref","DOI":"10.2196\/35042","article-title":"Digital Therapeutic Care Apps With Decision-Support Interventions for People With Low Back Pain in Germany: Cost-Effectiveness Analysis","volume":"10","author":"Lewkowicz","year":"2022","journal-title":"JMIR Mhealth Uhealth"},{"key":"2025121513045756000_14.9.e086800.38","doi-asserted-by":"crossref","DOI":"10.2196\/44585","article-title":"Economic Evaluation of Digital Therapeutic Care Apps for Unsupervised Treatment of Low Back Pain: Monte Carlo Simulation","volume":"11","author":"Lewkowicz","year":"2023","journal-title":"JMIR Mhealth Uhealth"},{"key":"2025121513045756000_14.9.e086800.39","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1038\/s41746-019-0109-x","article-title":"App-based multidisciplinary back pain treatment versus combined physiotherapy plus online education: a randomized controlled trial","volume":"2","author":"Toelle","year":"2019","journal-title":"NPJ Digit Med"},{"key":"2025121513045756000_14.9.e086800.40","doi-asserted-by":"crossref","DOI":"10.2196\/jmir.4521","article-title":"How to Measure Costs and Benefits of eHealth Interventions: An Overview of Methods and Frameworks","volume":"17","author":"Bergmo","year":"2015","journal-title":"J Med Internet Res"},{"key":"2025121513045756000_14.9.e086800.41","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1007\/s40122-020-00209-w","article-title":"A Comprehensive Review of Over the Counter Treatment for Chronic Low Back Pain","volume":"10","author":"Peck","year":"2021","journal-title":"Pain Ther"},{"key":"2025121513045756000_14.9.e086800.42","doi-asserted-by":"crossref","first-page":"852","DOI":"10.1016\/j.amepre.2016.05.007","article-title":"Designing and Undertaking a Health Economics Study of Digital Health Interventions","volume":"51","author":"McNamee","year":"2016","journal-title":"Am J Prev Med"},{"key":"2025121513045756000_14.9.e086800.43","unstructured":"Overview | digital technologies for managing non-specific low back pain: early value assessment | guidance | NICE. 2024. Available: https:\/\/www.nice.org.uk\/guidance\/hte16 [Accessed 26 Jun 2024]."},{"key":"2025121513045756000_14.9.e086800.44","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1177\/0272989X221132741","article-title":"Analytical Frameworks and Outcome Measures in Economic Evaluations of Digital Health Interventions: A Methodological Systematic Review","volume":"43","author":"Benedetto","year":"2023","journal-title":"Med Decis Making"},{"key":"2025121513045756000_14.9.e086800.45","unstructured":"Skogli E , Stokke OM . Vurdering av ny terskelverdien for et godt leve\u00e5r. 2023."}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-086800","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T21:05:06Z","timestamp":1765832706000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-086800"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9]]},"references-count":45,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2024,9,5]]},"published-print":{"date-parts":[[2024,9]]}},"alternative-id":["10.1136\/bmjopen-2024-086800"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-086800","relation":{"has-part":[{"id-type":"doi","id":"https:\/\/doi.org\/10.1136\/bmjopen-2024-086800.supp1","asserted-by":"subject"}]},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9]]}}}