(843): A cost-utility analysis of conservative chronic spinal pain management

Abstract

The present retrospective case review study sought to analyze the cost-utility, expressed in Cost/Quality-adjusted life years (QALYs), of current conservative chronic spinal pain treatments, as well as the QALY’s value as a clinically informative outcome measure. In addition, it expands upon previously published data evaluating the efficacy of interdisciplinary pain management, relative to medication management, in reducing the quantity and category of medication use. A recently developed algorithm was used to calculate QALYs using SF-36, v. 2 responses for 121 patients receiving treatment for chronic spinal pain at a pain rehabilitation center. Treatment groups evaluated were: (1) interdisciplinary program completers who also received medication management and supplementary anesthetic procedures; (2) interdisciplinary program completers also receiving medication management, but not anesthetic procedures; (3) patients receiving medication management alone; and (4) patients receiving medication management with supplemental anesthetic procedures. Assessments were conducted at pre-treatment and six-months after the initiation of treatment. Cost-utility analyses revealed that the interdisciplinary treatment alone group was cost-saving, relative to the medication and procedures alternative, suggesting the former modality was both less costly and more effective than the latter. Average cost-utility ratios for both interdisciplinary treatment groups, ranging from $57,627/QALY to $75,885/QALY, were within established cost-effective parameters ($20,000 to $100,000/QALY, generally considered a good value), while cost-utility ratios for the standard care treatment groups were not interpretable due to a decrease in QALYs from pre-treatment to post-treatment. Furthermore, pre- and post-treatment QALYs significantly correlated with well-developed measures of pain experience and functional disability, highlighting the QALY’s clinical utility as a measurement of patient health and well-being. Finally, post-treatment differences in the patients’ medication use were revealed among the four conservative spinal pain treatment groups. The present retrospective case review study sought to analyze the cost-utility, expressed in Cost/Quality-adjusted life years (QALYs), of current conservative chronic spinal pain treatments, as well as the QALY’s value as a clinically informative outcome measure. In addition, it expands upon previously published data evaluating the efficacy of interdisciplinary pain management, relative to medication management, in reducing the quantity and category of medication use. A recently developed algorithm was used to calculate QALYs using SF-36, v. 2 responses for 121 patients receiving treatment for chronic spinal pain at a pain rehabilitation center. Treatment groups evaluated were: (1) interdisciplinary program completers who also received medication management and supplementary anesthetic procedures; (2) interdisciplinary program completers also receiving medication management, but not anesthetic procedures; (3) patients receiving medication management alone; and (4) patients receiving medication management with supplemental anesthetic procedures. Assessments were conducted at pre-treatment and six-months after the initiation of treatment. Cost-utility analyses revealed that the interdisciplinary treatment alone group was cost-saving, relative to the medication and procedures alternative, suggesting the former modality was both less costly and more effective than the latter. Average cost-utility ratios for both interdisciplinary treatment groups, ranging from $57,627/QALY to $75,885/QALY, were within established cost-effective parameters ($20,000 to $100,000/QALY, generally considered a good value), while cost-utility ratios for the standard care treatment groups were not interpretable due to a decrease in QALYs from pre-treatment to post-treatment. Furthermore, pre- and post-treatment QALYs significantly correlated with well-developed measures of pain experience and functional disability, highlighting the QALY’s clinical utility as a measurement of patient health and well-being. Finally, post-treatment differences in the patients’ medication use were revealed among the four conservative spinal pain treatment groups.