Cost-Effectiveness of Radiofrequency Denervation for Patients With Chronic Low Back Pain: The MINT Randomized Clinical Trials

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DOI

  • Esther T. Maas, Vrije Universiteit Amsterdam, Amsterdam Movement Science Research Institute
  • ,
  • Johan N.S. Juch, Erasmus University Medical Centre
  • ,
  • Raymond W.J.G. Ostelo, Vrije Universiteit Amsterdam, Amsterdam Movement Science Research Institute
  • ,
  • J. George Groeneweg, Erasmus University Medical Centre
  • ,
  • Jan Willem Kallewaard, Rijnstate Hospital
  • ,
  • Bart W. Koes, Erasmus University Medical Centre
  • ,
  • Arianne P. Verhagen, University of Technology Sydney, Erasmus University Medical Centre
  • ,
  • Johanna M. van Dongen, Vrije Universiteit Amsterdam, Amsterdam Movement Science Research Institute
  • ,
  • Maurits W. van Tulder
  • Frank J.P.M. Huygen, Erasmus University Medical Centre

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.

OriginalsprogEngelsk
TidsskriftValue in Health
Vol/bind23
Nummer5
Sider (fra-til)585-594
Antal sider10
ISSN1098-3015
DOI
StatusUdgivet - maj 2020

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