Korean J Pain.  2018 Jan;31(1):27-38. 10.3344/kjp.2018.31.1.27.

Therapeutic lumbar facet joint nerve blocks in the treatment of chronic low back pain: cost utility analysis based on a randomized controlled trial

• Manchikanti L
• Pampati V
• Kaye AD
• Hirsch JA

• KMID: 2400905
• DOI: http://doi.org/10.3344/kjp.2018.31.1.27

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.

Keyword

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 Terms

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*
Therapeutic Uses

Figure

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  Fig. 1 Schematic presentation of patient flow at 2-year follow-up with therapeutic lumbar facet joint nerve blocks [7071].

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  Fig. 2 Data from randomized controlled trial of lumbar facet joint nerve blocks showing proportion of patients with significant reduction in Numeric Rating Score (NRS ≥ 50% reduction from baseline) and Oswestry Disability Index (ODI ≥ 40% reduction from baseline) [6970].

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