Current Trends in Low Back Pain Diagnostics in India: A Five-Year Scenario Analysis (2020-2024)

<i>Background</i>: Low back pain (LBP) represents a significant healthcare burden in India, with prevalence rates ranging from 6.2% to 92% across different populations. Despite evidence-based guidelines recommending conservative management and selective imaging, diagnostic overutilization remains a challenge across healthcare sectors. This study analyzed diagnostic utilization patterns and referral trends from various healthcare settings over a five-year period to evaluate the extent of inappropriate imaging use and its economic implications. <i>Objective</i>: To evaluate diagnostic imaging trends, referral patterns, guideline adherence, and positivity rates for lower back pain across different healthcare sectors in India, assess the extent of diagnostic overuse, and analyze cost-effectiveness patterns across private practice, specialist care, and insurance/government healthcare schemes. <i>Methods</i>: A retrospective analysis of simulated data representing diagnostic trends from to 2020-2024 across primary care practices (n=1,200), inpatient departments from secondary and tertiary care hospitals (n=450), insurance-covered services (n=850,000), and social organization healthcare programs (n=320) was conducted. Cases were classified using evidence-based clinical categories following the PRISMA guidelines, with outcome measures including diagnostic referral patterns, guideline adherence rates, positivity rates for actionable findings, and comprehensive cost-effectiveness analysis using Quality-Adjusted Life Years (QALYs). <i>Results</i>: Significant overutilization of imaging studies was observed across all sectors, with total LBP cases increasing by 71% over five years, while CT+MRI imaging rates rose dramatically from 70% to 88%. MRI utilization increased by 115% (1,512 to 3,252 studies), whereas cost-effective X-ray utilization declined by 31% (720 to 494 examinations). Total imaging costs escalated from ₹92.76 lakhs in 2020 to ₹1.95 crores in 2024, representing a 110% increase that substantially outpaced the case volume growth. Adherence to clinical guidelines remained consistently poor at 23-34% across sectors, with insurance/government schemes showing the worst compliance (15.2%) despite the highest imaging approval rates (95.8%). Cost-effectiveness analysis revealed stark disparities: private practice achieved ₹85,000 per QALY, while insurance/government sectors reached ₹1.65 lakhs per QALY, indicating poor economic efficiency despite subsidized rates. <i>Conclusions</i>: The analysis revealed a healthcare system paradox, wherein increased imaging intensity correlated with poorer clinical outcomes and economic efficiency. Urgent reforms, including MRI utilization controls, mandatory clinical reasoning documentation, and guideline-based audit programs, are essential to restore value-based care delivery.