Therapeutic lumbar facet joint nerve blocks in the treatment of chronic low back pain: cost utility analysis based on a randomized controlled trial
- Author:
Laxmaiah MANCHIKANTI
1
;
Vidyasagar PAMPATI
;
Alan D KAYE
;
Joshua A HIRSCH
Author Information
- Publication Type:Randomized Controlled Trial
- Keywords: Cost-benefit analysis; Cost effectiveness; Diagnostic techniques and procedures; Low back pain; Lumbar vertebrae; Nerve block; Quality-adjusted life years (QALY); Randomized controlled trial; Therapeutic uses; Zygapophyseal joint
- MeSH: Cost-Benefit Analysis; Diagnostic Techniques and Procedures; Evidence-Based Medicine; Follow-Up Studies; Health Care Costs; Humans; Low Back Pain; Lumbar Vertebrae; Nerve Block; Quality of Life; Quality-Adjusted Life Years; Therapeutic Uses; Treatment Outcome; Zygapophyseal Joint
- From:The Korean Journal of Pain 2018;31(1):27-38
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND: Related to escalating health care costs and the questionable effectiveness of multiple interventions including lumbar facet joint interventions, cost effectiveness or cost utility analysis has become the cornerstone of evidence-based medicine influencing coverage decisions. METHODS: Cost utility of therapeutic lumbar facet joint nerve blocks in managing chronic low back pain was performed utilizing data from a randomized, double-blind, controlled trial with a 2-year follow-up, with direct payment data from 2016. Based on the data from surgical interventions, utilizing the lowest proportion of direct procedural costs of 60%, total cost utility per quality adjusted life year (QALY) was determined by multiplying the derived direct cost at 1.67. RESULTS: Patients in this trial on average received 5.6 ± 2.6 procedures over a period of 2 years, with average relief over a period of 2 years of 82.8 ± 29.6 weeks with 19 ± 18.77 weeks of improvement per procedure. Procedural cost for one-year improvement in quality of life showed USD $2,654.08. Estimated total costs, including indirect costs and drugs with multiplication of direct costs at 1.67, showed a cost of USD $4,432 per QALY. CONCLUSIONS: The analysis of therapeutic lumbar facet joint nerve blocks in the treatment of chronic low back pain shows clinical effectiveness and cost utility at USD $2,654.08 for the direct costs of the procedures, and USD $4,432 for the estimated overall cost per one year of QALY, in chronic persistent low back pain non-responsive to conservative management.
