Objectives: The present retrospective case review study sought to analyze the cost-utility, expressed in cost/quality-adjusted life years (QALY), of current chronic spinal pain treatments. In addition, it expands upon previously published data evaluating the efficacy of interdisciplinary pain management in relation to medication management.
Methods: A recently developed algorithm was used to calculate QALYs using SF-36, v. 1 responses for 121 patients receiving treatment for chronic spinal pain at a pain rehabilitation center. Treatment groups evaluated were: (1) interdisciplinary program completers who received medication management and supplementary anesthetic procedures; (2) interdisciplinary program completers receiving medication management but not anesthetic procedures; (3) patients receiving medication management alone; and (4) patients receiving medication management with supplemental anesthetic procedures. Assessments were conducted at pretreatment and 6 months after the initiation of treatment.
Results: One-way analyses of covariance indicated that patients who participated in an interdisciplinary pain management program, which included medication management, psychotherapy, group education, and physical therapy, reported significantly less impairment in daily activities of living, less subjective experience of pain, and a higher quality of life and more preferred health state at the completion of their treatment phase, relative to patients receiving medication with or without anesthetic procedures. In addition, improvements in all outcome measures between pretreatment and posttreatment were significantly greater for those patients completing the interdisciplinary component of treatment. Cost-utility analyses revealed that the interdisciplinary treatment alone group was cost-saving, relative to the medication and procedures alternative, suggesting the former modality was both less costly and more effective than the latter.
Discussion: Average cost-utility ratios for both interdisciplinary treatment groups, ranging from 57,627 dollars /QALY to 75,885 dollars /QALY, were within established cost-effective parameters (20,000 dollars to 100,000 dollars /QALY, generally considered a good value), whereas cost-utility ratios for the standard care treatment groups were not interpretable because of a decrease in QALYs from pretreatment to posttreatment.