scholarly journals Cost Utility Analysis of Lumbar Interlaminar Epidural Injections in the Treatment of Lumbar Disc Herniation, Central Spinal Stenosis, and Axial or Discogenic Low Back Pain

2017 ◽  
Vol 4 (20;4) ◽  
pp. 219-228 ◽  
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Spinal Stenosis ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Low Back ◽  
Utility Analysis ◽  
Epidural Injections

Background: Cost utility or cost effective analysis continues to take center stage in the United States for defining and measuring the value of treatments in interventional pain management. Appropriate cost utility analysis has been performed for caudal epidural injections, percutaneous adhesiolysis, and spinal cord stimulation. However, the literature pertaining to lumbar interlaminar epidural injections is lacking, specifically in reference to cost utility analysis derived from randomized controlled trials (RCTs) with a pragmatic approach in a practical setting. Objectives: To assess the cost utility of lumbar interlaminar epidural injections in managing chronic low back and/or lower extremity pain secondary to lumbar disc herniation, spinal stenosis, and axial or discogenic low back pain. Study Design: Analysis based on 3 previously published randomized trials of effectiveness of lumbar interlaminar epidural injections assessing their role in disc herniation, spinal stenosis, and axial or discogenic pain. Setting: A contemporary, private, specialty referral interventional pain management center in the United States. Methods: Cost utility of lumbar interlaminar epidural injections with or without steroids in managing lumbar disc herniation, central spinal stenosis, and discogenic or axial low back pain was conducted with data derived from 3 RCTs that included a 2-year follow-up, with inclusion of 360 patients. The primary outcome was significant improvement defined as at least a 50% in pain reduction and disability status. Direct payment data from 2016 was utilized for assessment of procedural costs. Overall costs, including drug costs, were determined by multiplication of direct procedural payment data by a factor of 1.67 to accommodate for indirect payments respectively for disc herniation, spinal stenosis, discogenic pain. Results: The results of 3 RCTs showed direct cost utility for one year of quality-adjusted life year (QALY) of $2,050.87 for disc herniation, $2,112.25 for axial or discogenic pain without disc herniation, and $1,773.28 for spinal stenosis, with an average cost per one year QALY of $1,976.58, with total estimated costs of $3,425, $3,527, $2,961, and $3,301 respectively. Limitations: The limitation of this cost utility analysis includes that it is a single center evaluation, even though 360 patients were included in this analysis. Further, only the costs of interventional procedures and physician visits were assessed based on the data, with extrapolation of indirect costs presenting the overall total costs. The benefits of returning to work were not assessed. Conclusion: This cost utility analysis of lumbar interlaminar epidural injections in patients nonresponsive to conservative management in the treatment of disc herniation, central spinal stenosis, and axial or discogenic low back pain in the lumbar spine shows the clinical effectiveness and cost utility of these injections of $1,976.58 for direct costs with a total cost of $3,301 per QALY.Key words: Lumbar interlaminar epidural injections, chronic low back pain, lumbar disc herniation, lumbar discogenic pain, cost utility analysis, cost effectiveness analysis, qualityadjusted life years

scholarly journals Cost Utility Analysis of Caudal Epidural Injections in the Treatment of Lumbar Disc Herniation, Axial or Discogenic Low Back Pain, Central Spinal Stenosis, and Post Lumbar Surgery Syndrome

2013 ◽  
Vol 3;16 (3;5) ◽  
pp. E129-E143 ◽  
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Spinal Stenosis ◽  
Disc Herniation ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Low Back ◽  
Utility Analysis ◽  
Epidural Injections ◽  
Caudal Epidural

Background: In this era of escalating health care costs and the questionable effectiveness of multiple interventions, cost effectiveness or cost utility analysis has become the cornerstone of evidence-based medicine, and has an influence coverage decisions. Even though multiple cost effectiveness analysis studies have been performed over the years, extensive literature is lacking for interventional techniques. Cost utility analysis studies of epidural injections for managing chronic low back pain demonstrated highly variable results including a lack of cost utility in randomized trials and contrasting results in observational studies. There has not been any cost utility analysis studies of epidural injections in large randomized trials performed in interventional pain management settings. Objectives: To assess the cost utility of caudal epidural injections in managing chronic low back pain secondary to lumbar disc herniation, axial or discogenic low back pain, lumbar central spinal stenosis, and lumbar post surgery syndrome. Study Design: This analysis is based on 4 previously published randomized trials. Setting: A private, specialty referral interventional pain management center in the United States. Methods: Four randomized trials were conducted assessing the clinical effectiveness of caudal epidural injections with or without steroids for lumbar disc herniation, lumbar discogenic or axial low back pain, lumbar central spinal stenosis, and post surgery syndrome. A cost utility analysis was performed with direct payment data for a total of 480 patients over a period of 2 years from these 4 trials. Outcome included various measures with significant improvement defined as at least a 50% improvement in pain reduction and disability status. Results: The results of 4 randomized controlled trials of low back pain with 480 patients with a 2 year follow-up with the actual reimbursement data showed cost utility for one year of quality-adjusted life year (QALY) of $2,206 for disc herniation, $2,136 for axial or discogenic pain without disc herniation, $2,155 for central spinal stenosis, and $2,191 for post surgery syndrome. All patients showed significant improvement clinically and showed positive results in the cost utility analysis with an average cost per one year QALY of $2,172.50 for all patients and $1,966.03 for patients judged to be successful. The results of this assessment show a better cost utility or lower cost of managing chronic, intractable low back pain with caudal epidural injections at a QALY that is similar or lower in price than medical therapy only, physical therapy, manipulation, and surgery in most cases. Limitations: The limitations of this cost utility analysis include that it is a single center evaluation, even though 480 patients were included in the analysis. Further, only the costs of interventional procedures and physician visits were included. The benefits of returning to work were not assessed. Conclusion: This cost utility analysis of caudal epidural injections in the treatment of disc herniation, axial or discogenic low back pain, central spinal stenosis, and post surgery syndrome in the lumbar spine shows the clinical effectiveness and cost utility of these injections at less than $2,200 per one year of QALY. Key words: Caudal epidural injections, chronic low back pain, lumbar disc herniation, lumbar discogenic pain, lumbar spinal stenosis, lumbar post surgery syndrome, cost utility analysis, cost effectiveness analysis, quality-adjusted life years

scholarly journals PND43 Cost-Utility Analysis Patients With Low Back Pain After Treatment Intraosseous Blockades

2012 ◽  
Vol 15 (7) ◽  
pp. A553
Author(s):  
M.V. Yakovlev ◽  
A.U. Kulikov ◽  
E.L. Sokov ◽  
L.E. Kornilova
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Low Back ◽  
Utility Analysis

Lumbar Epidural Injections: Fluoroscopy

2016 ◽  
Author(s):  
Dmitri Souzdalnitski ◽  
Pavan Tankha ◽  
Imanuel R. Lerman
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Spinal Stenosis ◽  
Disc Herniation ◽  
Epidural Injection ◽  
Neurogenic Claudication ◽  
Foraminal Stenosis ◽  
Low Back ◽  
Epidural Injections ◽  
Radicular Symptoms

Lumbar epidural injection is most often performed for patients experiencing low back pain with radicular symptoms. The radicular symptoms can be precipitated by disc herniation or foraminal stenosis. In addition, spinal stenosis with associated neurogenic claudication is another common indication for this injection. These procedures may be effective in treatment of other syndromes that are associated with radiculopathic low back pain, including intervertebral disc degeneration without disc herniation, central spinal stenosis, spondylothesis, and failed lumbar back surgery syndrome. Lumbar epidural steroid injection (LESI) is the most commonly performed intervention. Fluoroscopically guided lumbar epidural injections led to a lower rate of complications than that reported for all lumbar epidural injections.

scholarly journals Systematic Review of Caudal Epidural Injections in the Management of Chronic Low Back Pain

2009 ◽  
Vol 1;12 (1;1) ◽  
pp. 109-135
Author(s):  
Ann Conn
Keyword(s):  
Chronic Pain ◽  
Low Back Pain ◽  
Back Pain ◽  
Lower Extremity ◽  
Spinal Stenosis ◽  
Disc Herniation ◽  
Low Back ◽  
Discogenic Pain ◽  
Epidural Injections ◽  
Caudal Epidural

Background: Caudal epidural injection of local anesthetics with or without steroids is one of the most commonly used interventions in managing chronic low back and lower extremity pain. However, there has been a lack of well-designed randomized, controlled studies to determine the effectiveness of caudal epidural injections in various conditions — disc herniation and radiculitis, post-lumbar laminectomy syndrome, spinal stenosis, and chronic low back pain of disc origin without disc herniation or radiculitis. Study Design: A systematic review of caudal epidural injections with or without steroids in managing chronic pain secondary to lumbar disc herniation or radiculitis, post lumbar laminectomy syndrome, spinal stenosis, and discogenic pain without disc herniation or radiculitis. Objective: To evaluate the effect of caudal epidural injections with or without steroids in managing various types of chronic low back and lower extremity pain emanating as a result of disc herniation or radiculitis, post-lumbar laminectomy syndrome, spinal stenosis, and chronic discogenic pain. Methods: A review of the literature was performed according to the Cochrane Musculoskeletal Review Group Criteria as utilized for interventional techniques for randomized trials and the Agency for Healthcare Research and Quality (AHRQ) criteria for observational studies. The level of evidence was classified as Level I, II, or III based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature of the English language identified through searches of PubMed and EMBASE from 1966 to November 2008, and manual searches of bibliographies of known primary and review articles. Outcome Measures: The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term ≥ 6 months). Secondary outcome measures of improvement in functional status, psychological status, return to work, and reduction in opioid intake were utilized. Results: The evidence showed Level I for short- and long-term relief in managing chronic low back and lower extremity pain secondary to lumbar disc herniation and/or radiculitis and discogenic pain without disc herniation or radiculitis. The indicated evidence is Level II-1 or II-2 for caudal epidural injections in managing low back pain of post-lumbar laminectomy syndrome and spinal stenosis. Limitations: The limitations of this study include the paucity of literature, specifically for chronic pain without disc herniation. Conclusion: This systematic review shows Level I evidence for relief of chronic pain secondary to disc herniation or radiculitis and discogenic pain without disc herniation or radiculitis. Further, the indicated evidence is Level II-1 or II-2 for caudal epidural injections in managing chronic pain of post lumbar laminectomy syndrome and spinal stenosis. Key words: Chronic low back pain, lower extremity pain, lumbar disc herniation, lumbar radiculitis, lumbar discogenic pain, post lumbar laminectomy or surgery syndrome, spinal stenosis, caudal epidural injections, steroids, local anesthetic

Sign in / Sign up

Export Citation Format

Share Document