Author: Herman PM1, Anderson ML, Sherman KJ, Balderson BH, Turner JA, Cherkin DC
Affiliation: <sup>1</sup>*RAND Corporation, Santa Monica, CA †Group Health Research Institute, Seattle, Washington ‡Department of Epidemiology, University of Washington, Seattle §Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle; Department of Rehabilitation Medicine, University of Washington, Seattle ¶Department of Health Services, University of Washington, Seattle; Department of Family Medicine, University of Washington, Seattle.
Conference/Journal: Spine (Phila Pa 1976).
Date published: 2017 Jul 24
Other:
Special Notes: doi: 10.1097/BRS.0000000000002344. [Epub ahead of print] , Word Count: 282
STUDY DESIGN: Economic evaluation alongside a randomized trial of cognitive-behavioral therapy (CBT) and mindfulness-based stress reduction (MBSR) versus usual care alone (UC) for chronic low-back pain (CLBP).
OBJECTIVE: Determine the one-year cost-effectiveness of CBT and MBSR compared to UC.
SUMMARY OF BACKGROUND DATA: CLBP is expensive in terms of healthcare costs and lost productivity. Mind-body interventions have been found effective for back pain, but their cost-effectiveness is unexplored.
METHODS: 342 adults in an integrated healthcare system with CLBP were randomized to receive MBSR (n = 116), CBT (n = 113), or UC (n = 113). CBT and MBSR were offered in 8 weekly 2-hour group sessions. Cost-effectiveness from the societal perspective was calculated as the incremental sum of healthcare costs and productivity losses over change in quality-adjusted life-years (QALYs). The payer perspective only included healthcare costs. This economic evaluation was limited to the 301 health plan members enrolled >=180 days in the years pre-and post-randomization.
RESULTS: Compared to UC, the mean incremental cost per participant to society of CBT was $125 (95% CI: -4103, 4307) and of MBSR was -$724 (CI: -4386, 2778)-i.e., a net saving of $724. Incremental costs per participant to the health plan were $495 for CBT over UC and -$982 for MBSR, and incremental back-related costs per participant were $984 for CBT over UC and -$127 for MBSR. These costs (and cost savings) were associated with statistically significant gains in QALYs over UC: 0.041 (0.015, 0.067) for CBT and 0.034 (0.008, 0.060) for MBSR.
CONCLUSIONS: In this setting CBT and MBSR have high probabilities of being cost-effective, and MBSR may be cost saving, as compared to UC for adults with CLBP. These findings suggest that MBSR, and to a lesser extent CBT, may provide cost-effective treatment for CLBP for payers and society.
LEVEL OF EVIDENCE: 2.
PMID: 28742756 DOI: 10.1097/BRS.0000000000002344