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

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.

Keywords: Cost effectiveness; Cost-benefit analysis; Diagnostic techniques and procedures; Low back pain; Lumbar vertebrae; Nerve block; Quality-adjusted life years (QALY); Randomized controlled trial; Therapeutic uses; Zygapophyseal joint.

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

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].