Cost-Effectiveness of Cervical Epidural Steroid Injections: A 3-Month Pilot Study.

Autor:	Alvin MD; The Johns Hopkins Hospital, Baltimore, MD, USA., Mehta V; Duke University School of Medicine, Durham, NC, USA., Halabi HA; Alfaisal University College of Medicine, Riyadh, Saudi Arabia., Lubelski D; The Johns Hopkins Hospital, Baltimore, MD, USA., Benzel EC; Cleveland Clinic, Cleveland, Ohio, USA., Mroz TE; Cleveland Clinic, Cleveland, Ohio, USA.
Jazyk:	angličtina
Zdroj:	Global spine journal [Global Spine J] 2019 Apr; Vol. 9 (2), pp. 143-149. Date of Electronic Publication: 2018 Jul 31.
DOI:	10.1177/2192568218764913
Abstrakt:	Study Design: Retrospective cohort. Objectives: There are conflicting reports on the short- and long-term quality of life (QOL) outcomes and cost-effectiveness of cervical epidural steroid injections (ESIs). The present study analyzes the cost-effectiveness analysis of ESIs versus conservative management for patients with radiculopathy or neck pain in the short term. Methods: Fifty patients who underwent cervical ESI and 29 patients who received physical therapy and pain medication alone for cervical radiculopathy and neck pain of <6 months duration were included. Three-month postoperative health outcomes were assessed based on EuroQol-5 Dimensions (EQ-5D; measured in quality-adjusted life years [QALYs]). Medical costs were estimated using Medicare national payment amounts. Cost/utility ratios and the incremental cost-effectiveness ratio (ICER) were calculated to assess for cost-effectiveness. Results: The ESI cohort experienced significant ( P < .01) improvement in the EQ-5D score while the control cohort did not (0.13 vs 0.02 QALYs, respectively; P = .01). There were no significant differences in costs between the cohorts. The cost-utility ratio for the ESI cohort was significantly lower ($21 884/QALY gained) than that for the control cohort ($176 412/QALY gained) ( P < .01). The ICER for an ESI versus conservative management was negative, indicating that ESIs provide greater improvement in QOL at a lower cost. Conclusions: ESIs provide significant improvement in QOL within 3 months for patients with cervical radiculopathy and neck pain. ESIs are more cost-effective compared than conservative management alone in the shor -term. The durability of these results must be analyzed with longer term cost-utility analysis studies. Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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