Elsevier

Value in Health

Volume 23, Issue 5, May 2020, Pages 585-594
Value in Health

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

https://doi.org/10.1016/j.jval.2019.12.009Get rights and content
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Highlights

  • The clinical findings of the MINT randomized clinical trials did not support radiofrequency denervation as an add-on to a standardized exercise program when visiting a pain clinic within 3 months after an intervention for chronic low back pain. Radiofrequency denervation for chronic low back pain should instead be performed in a research setting, with a focus on patient selection, treatment techniques, and outcome parameters.

  • In the Dutch healthcare setting, evidence suggests that radiofrequency denervation (performed with the Dutch selection and treatment techniques) combined with a standardized exercise program is not considered cost-effective from a societal perspective for patients with chronic mechanical low back pain originating from either facet or sacroiliac joints compared with a standardized exercise program alone.

Abstract

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.

Keywords

economic evaluation
low back pain
radiofrequency denervation
randomized controlled trials

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