Are Nonpharmacologic Interventions for Chronic Low Back Pain More Cost Effective Than Usual Care? Proof of Concept Results From a Markov Model

STUDY DESIGN. Markov model. OBJECTIVE. Examine the one-year effectiveness and cost-effectiveness (societal and payer perspectives) of adding nonpharmacologic interventions for chronic low back pain (CLBP) to usual care using a decision analytic model-based approach. SUMMARY OF BACKGROUND DATA. Treatment guidelines now recommend many safe and effective nonpharmacologic interventions for CLBP. However, little is known regarding their effectiveness in subpopulations (e.g., high-impact chronic pain patients), nor about their cost-effectiveness. METHODS. 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. The model was run for nine 6-week cycles to approximate a 1-year time horizon. Quality-adjusted life-year (QALY) weights were based on six-dimensional health state short form (SF-6D) scores; healthcare costs were based on 2003–2015 Medical Expenditure Panel Survey data; and lost productivity costs used in the societal perspective were based on reported absenteeism. Results were generated for two target populations, 1) a typical baseline mix of patients with CLBP (25% low-impact, 35% moderate-impact and 40% high-impact chronic pain) and, 2) high-impact chronic pain patients. RESULTS. From the societal perspective, all but two of the therapies were cost-effective (