Update of Markov Model on the Cost-effectiveness of Nonpharmacologic Interventions for Chronic Low Back Pain Compared to Usual Care

Spine
Patricia M HermanIan D Coulter

Abstract

Markov model. Further validity test of a previously published model. 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. 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. 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 num...Continue Reading

References

Dec 21, 2005·Annals of Internal Medicine·Karen J ShermanRichard A Deyo
Nov 2, 2011·Annals of Internal Medicine·Helen E TilbrookDavid J Torgerson
Jun 21, 2017·Annals of Internal Medicine·Robert B SaperJanice Weinberg
Mar 20, 2019·The Spine Journal : Official Journal of the North American Spine Society·Patricia M HermanIan D Coulter

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