TY - JOUR
T1 - Cost-Effectiveness of Radiofrequency Denervation for Patients With Chronic Low Back Pain
T2 - The MINT Randomized Clinical Trials
AU - Maas, Esther T
AU - Juch, Johan N S
AU - Ostelo, Raymond W J G
AU - Groeneweg, J George
AU - Kallewaard, Jan-Willem
AU - Koes, Bart W
AU - Verhagen, Arianne P
AU - van Dongen, Johanna M
AU - van Tulder, Maurits W
AU - Huygen, Frank J P M
N1 - Funding Information: This study was funded by grant 171202013 from the Netherlands Organization for Health Research and Development, by the Dutch Society for Anesthesiology, and the Dutch health insurance companies. We thank Merel van Raamt, PT, and Robert van Cingel, PhD (Sports Medical Centre Papendal [SMCP]), for their help in developing the exercise program. SMCP received financial support from the research grant for the development of the protocol. We also thank all participants, physiotherapists, and everyone working at the participating pain clinics. The participating pain clinics received reimbursement from the research grant for their extra study-related administrative tasks. Publisher Copyright: © 2020 ISPOR–The Professional Society for Health Economics and Outcomes Research Copyright: Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/5
Y1 - 2020/5
N2 - OBJECTIVES: To evaluate the cost-effectiveness of radiofrequency denervation when added to a standardized exercise program for patients with chronic low back pain.METHODS: An economic evaluation was conducted alongside 3 pragmatic multicenter, nonblinded randomized clinical trials (RCTs) in The Netherlands with a follow up of 52 weeks. Eligible participants were included between January 1, 2013, and October 24, 2014, and had chronic low back pain; a positive diagnostic block at the facet joints (n = 251), sacroiliac (SI) joints (n = 228), or a combination of facet joints, SI joints, and intervertebral discs (n = 202); and were unresponsive to initial conservative care. Quality-adjusted life-years (QALYs) and societal costs were measured using self-reported questionnaires. Missing data were imputed using multiple imputation. Bootstrapping was used to estimate statistical uncertainty.RESULTS: After 52 weeks, no difference in costs between groups was found in the facet joint or combination RCT. The total costs were significantly higher for the intervention group in the SI joint RCT. The maximum probability of radiofrequency denervation being cost-effective when added to a standardized exercise program ranged from 0.10 in the facet joint RCT to 0.17 in the SI joint RCT irrespective of the ceiling ratio, and 0.65 at a ceiling ratio of €30 000 per QALY in the combination RCT.CONCLUSIONS: Although equivocal among patients with symptoms in a combination of the facet joints, SI joints, and intervertebral discs, evidence suggests that radiofrequency denervation combined with a standardized exercise program cannot be considered cost-effective from a societal perspective for patients with chronic low back pain originating from either facet or SI joints in a Dutch healthcare setting.
AB - OBJECTIVES: To evaluate the cost-effectiveness of radiofrequency denervation when added to a standardized exercise program for patients with chronic low back pain.METHODS: An economic evaluation was conducted alongside 3 pragmatic multicenter, nonblinded randomized clinical trials (RCTs) in The Netherlands with a follow up of 52 weeks. Eligible participants were included between January 1, 2013, and October 24, 2014, and had chronic low back pain; a positive diagnostic block at the facet joints (n = 251), sacroiliac (SI) joints (n = 228), or a combination of facet joints, SI joints, and intervertebral discs (n = 202); and were unresponsive to initial conservative care. Quality-adjusted life-years (QALYs) and societal costs were measured using self-reported questionnaires. Missing data were imputed using multiple imputation. Bootstrapping was used to estimate statistical uncertainty.RESULTS: After 52 weeks, no difference in costs between groups was found in the facet joint or combination RCT. The total costs were significantly higher for the intervention group in the SI joint RCT. The maximum probability of radiofrequency denervation being cost-effective when added to a standardized exercise program ranged from 0.10 in the facet joint RCT to 0.17 in the SI joint RCT irrespective of the ceiling ratio, and 0.65 at a ceiling ratio of €30 000 per QALY in the combination RCT.CONCLUSIONS: Although equivocal among patients with symptoms in a combination of the facet joints, SI joints, and intervertebral discs, evidence suggests that radiofrequency denervation combined with a standardized exercise program cannot be considered cost-effective from a societal perspective for patients with chronic low back pain originating from either facet or SI joints in a Dutch healthcare setting.
KW - economic evaluation
KW - low back pain
KW - radiofrequency denervation
KW - randomized controlled trials
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U2 - https://doi.org/10.1016/j.jval.2019.12.009
DO - https://doi.org/10.1016/j.jval.2019.12.009
M3 - Article
C2 - 32389224
SN - 1098-3015
VL - 23
SP - 585
EP - 594
JO - Value in Health
JF - Value in Health
IS - 5
ER -