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Cost effectiveness of epidural steroid injections to manage chronic lower back pain

Whynes, David K.; McCahon, Robert A.; Ravenscroft, Andrew; Hardman, Jonathan

Authors

David K. Whynes

Robert A. McCahon

Andrew Ravenscroft

Jonathan Hardman

Abstract

Background
The efficacy of epidural steroid injections in the management of chronic low back pain is disputed, yet the technique remains popular amongst physicians and patients alike. This study assesses the cost effectiveness of injections administered in a routine outpatient setting in England.

Methods
Patients attending the Nottingham University Hospitals’ Pain Clinic received two injections of methylprednisolone plus levobupivacaine at different dosages, separated by at least 12 weeks. Prior to each injection, and every week thereafter for 12 weeks, participants completed the EQ-5D health-related quality of life instrument. For each patient for each injection, total health state utility gain relative to baseline was calculated. The cost of the procedure was modelled from observed clinical practice. Cost effectiveness was calculated as procedure cost relative to utility gain.

Results
39 patients provided records. Over a 13-week period commencing with injection, mean quality adjusted life year (QALY) gains per patient for the two dosages were 0.028 (SD 0.063) and 0.021 (SD 0.057). The difference in QALYs gained by dosage was insignificant (paired t-test, CIs -0.019 – 0.033). Based on modelled resource use and data from other studies, the mean cost of an injection was estimated at £219 (SD 83). The cost utility ratio of the two injections amounted to £8,975 per QALY gained (CIs 5,480 – 22,915). However, at costs equivalent to the tariff price typically paid to providers by health care purchasers, the ratio increased to £27,459 (CIs 16,779 – 70,091).

Conclusions
When provided in an outpatient setting, epidural steroid injections are a short term, but nevertheless cost effective, means of managing chronic low back pain. However, designation of the procedure as a day case requires the National Health Service to reimburse providers at a price which pushes the procedure to the margin of cost effectiveness.

Journal Article Type Article
Publication Date Sep 27, 2012
Journal BMC Anesthesiology
Electronic ISSN 1471-2253
Publisher Humana Press
Peer Reviewed Peer Reviewed
Volume 12
Issue 26
Article Number 26
Institution Citation Whynes, D. K., McCahon, R. A., Ravenscroft, A., & Hardman, J. (2012). Cost effectiveness of epidural steroid injections to manage chronic lower back pain. BMC Anesthesiology, 12(26), doi:10.1186/1471-2253-12-26
DOI https://doi.org/10.1186/1471-2253-12-26
Publisher URL http://www.biomedcentral.com/1471-2253/12/26
Copyright Statement Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0




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