Does it work and is it cost-effective…two “questions of the hour” in healthcare.
Researchers from the Rand Corporation, Tufts Medical Center, and the University of Hawaii have taken on those questions when it comes to back pain.
Their study, “Are Nonpharmacologic Interventions for Chronic Low Back Pain More Cost Effective Than Usual Care? Proof of Concept Results From a Markov Model,” appears in the October 15, 2019 edition of Spine.
Co-author Patricia M. Herman, N.D., Ph.D. with the Rand Corporation in Santa Monica, California, explained the purpose and genesis of this study to OTW, “There is a tendency to look at nonpharmacologic therapies such as acupuncture and spinal manipulation and consider them solely as additional costs.”
“It is often true that adding these complementary therapies to usual care increases the upfront cost of treatment. However, if these therapies are effective and improve patients’ health, they can also reduce ongoing healthcare costs—and at times reduce those costs enough to more than pay for the additional up-front costs.”
“Although the evidence for the effectiveness of these therapies is growing, there are still few economic evaluations. This study offers a set of estimates based on individual patient data of the added effectiveness of these therapies over usual care when all therapies are applied to the same patient mix and allows consistent estimates of their economic outcomes even if those outcomes were not included in the underlying studies.”
For this work, researchers used a decision analytic model-based approach. They noted, “The model included four health states: high-impact chronic pain (substantial activity limitations); no pain; and two others without activity limitations, but with higher (moderate-impact) or lower (low-impact) pain. We estimated intervention-specific transition probabilities for these health states using individual patient-level data from 10 large randomized trials covering 17 nonpharmacologic therapies…”
Dr. Herman summarized the key takeaway from the study to OTW, “The most important results were that most of nonpharmacologic therapies we could include in the model were more effective and cost effective than usual care alone, and that many had the potential for cost savings over the model’s one-year time horizon.”
“Another important result was the benefits this type of modeling provides over simple systematic reviews and meta-analyses. These benefits include being able to: balance baseline patient severity mix across studies, examine the impact of the therapies on patients with various levels of chronic pain severity/impact, use consistent measures of health outcomes and include economic impacts. One major limitation of this modeling exercise was that we were not able to include all studies of nonpharmacologic therapies for chronic low back pain.”
“We only included studies with at least 50 patients per arm, that used the most common outcome measures, that had a study duration of at least 6 months, and that would share their data. We are working on expanding the model to include more studies.”
“The main recommendation is that these nonpharmacologic therapies can improve health and economic outcomes and should not be avoided because of their higher upfront costs. The other recommendation is that we need to look closer at the types of these therapies that have the best outcomes for patients who need them most—i.e., those with high-impact chronic pain.”
“I would like orthopedic surgeons to know that there is growing evidence for the effectiveness and cost effectiveness of these nonpharmacologic therapies, and that they could be reasonable additions for patients undergoing or waiting for surgery or for whom surgery is not an option.”
For more information visit Rand’s website.
