Update of Markov Model on the Cost-effectiveness of Nonpharmacologic Interventions for Chronic Low Back Pain Compared to Usual Care.
Study Goal
The researchers aimed to compare the cost-effectiveness and effectiveness of mindfulness-based stress reduction (MBSR) with other nonpharmacologic interventions for chronic low back pain (CLBP), particularly for patients with high-impact chronic pain.
Results Summary
Mindfulness-based stress reduction was found to be similarly effective as cognitive behavioral therapy (CBT) for a typical patient mix but twice as effective for those with high-impact chronic pain. The study also noted that MBSR was cost-effective and demonstrated cost savings from a societal perspective.
Population
Patients with chronic low back pain (CLBP), categorized into low-impact, moderate-impact, and high-impact chronic pain subgroups.
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
most interventions (including newly added) | no change | cost-effectiveness | CLBP patients with typical patient mix (25% low-impact, 35% moderate-impact, and 40% high-impact chronic pain) | <$50,000/QALY | were cost-effective | #1 |
most interventions (including newly added) | decrease | costs | CLBP patients with typical patient mix (25% low-impact, 35% moderate-impact, and 40% high-impact chronic pain) from societal perspective | - | demonstrated cost savings | #2 |
most interventions (including newly added) | no change | cost-effectiveness | CLBP patients with typical patient mix (25% low-impact, 35% moderate-impact, and 40% high-impact chronic pain) from payer perspective | <$50,000/QALY | were cost-effective | #3 |
fewer interventions | decrease | costs | CLBP patients with typical patient mix (25% low-impact, 35% moderate-impact, and 40% high-impact chronic pain) from payer perspective | - | were cost-saving | #4 |
cognitive behavioral therapy (CBT) | no change | effectiveness and cost-effectiveness | CLBP patients | - | results for new studies generally mirrored others using the same intervention | #5 |
physical therapy | no change | effectiveness and cost-effectiveness | CLBP patients | - | results for new studies generally mirrored others using the same intervention | #6 |
acupuncture | no change | effectiveness | CLBP patients in new study vs other acupuncture studies | - | had similar effectiveness | #7 |
acupuncture | increase | cost savings | CLBP patients in new study vs other acupuncture studies | - | resulting in higher cost savings | #8 |
yoga | no change | effectiveness and cost-effectiveness | CLBP patients in two new studies | - | results were similar | #9 |
yoga | no change | effectiveness and cost-effectiveness | CLBP patients in two new studies vs original yoga study | - | both differed from those of the original yoga study | #10 |
mindfulness-based stress reduction | no change | effectiveness and cost-effectiveness | CLBP patients with typical patient mix (25% low-impact, 35% moderate-impact, and 40% high-impact chronic pain) | - | was similar to CBT | #11 |
mindfulness-based stress reduction | increase | effectiveness | CLBP patients with high-impact chronic pain | twice | was twice as effective | #12 |
STUDY DESIGN: Markov model. OBJECTIVE: Further validity test of a previously published model. SUMMARY OF BACKGROUND DATA: The previous model was built using data from ten randomized trials and examined the 1-year effectiveness and cost-effectiveness of 17 nonpharmacologic interventions for chronic low back pain (CLBP), each compared to usual care alone. This update incorporated data from five additional trials. METHODS: Based on transition probabilities that were estimated using patient-level trial data, a hypothetical cohort of CLBP patients transitioned over time among four defined health states: high-impact chronic pain with substantial activity limitations; higher (moderate-impact) and lower (low-impact) pain without activity limitations; and no pain. As patients transitioned among health states, they accumulated quality-adjusted life-years, as well as healthcare and productivity costs. Costs and effects were calculated incremental to each study's version of usual care. RESULTS: From the societal perspective and assuming a typical patient mix (25% low-impact, 35% moderate-impact, and 40% high-impact chronic pain), most interventions-including those newly added-were cost-effective (<$50,000/QALY) and demonstrated cost savings. From the payer perspective, fewer were cost-saving, but the same number were cost-effective. Results for the new studies generally mirrored others using the same interventions-for example, cognitive behavioral therapy (CBT) and physical therapy. A new acupuncture study had similar effectiveness to other acupuncture studies, but higher usual care costs, resulting in higher cost savings. Two new yoga studies' results were similar, but both differed from those of the original yoga study. Mindfulness-based stress reduction was similar to CBT for a typical patient mix but was twice as effective for those with high-impact chronic pain. CONCLUSION: Markov modeling facilitates comparisons across interventions not directly compared in trials, using consistent outcome measures after balancing the baseline mix of patients. Outcomes also differed by pain impact level, emphasizing the need to measure CLBP subgroups. LEVEL OF EVIDENCE: N/A.