Cost-effectiveness of Lumbar Epidural XXXX Injections.

@entity1 @entity179 @entity479
STUDY DESIGN: Longitudinal cohort. OBJECTIVE: To determine the cost per quality-adjusted life-year for lumbar epidural @entity479 injections (LESI). SUMMARY OF BACKGROUND DATA: Despite being a widely performed procedure, there are few studies evaluating the cost-effectiveness of LESIs. METHODS: @entity1 who had received LESI between June 2012 and July 2013 with EQ-5D scores available before and after LESIs but before any surgical intervention were identified. Costs were calculated on the basis of the Medicare Fee Schedule multiplied by the number of LESIs received between the 2 clinic visits. Quality-adjusted life-years (QALYs) were calculated using the EQ-5D. RESULTS: Of 421 @entity1 who had pre-LESI EQ-5D data, 323 (77%) had post-LESI data available; 200 females, 123 males, mean age: 59.2  14.2 years. Cost per LESI was  608, with most @entity1 receiving 3 LESIs for more than 1 year (range: 1-6 yr). Mean QALY gained was 0.005. One hundred forty-five @entity1 (45%) had a QALY gain (mean=0.117) at a cost of  62,175 per QALY gained; 127 @entity1 (40%) had a loss in QALY (mean=-0.120) and 51 @entity1 (15%) had no change in QALY. Fourteen of the 145 @entity1 who improved, and 29 of the 178 @entity1 who did not, have medical comorbidities that precluded surgery. Thirty-two (22%) of 131 @entity1 without medical comorbidities who improved and 57 (32%) of 149 @entity1 without medical comorbidities who did not improve subsequently had undergone surgery (P=0.015). CONCLUSION: LESI may not be cost-effective in @entity1 with @entity179 . For the 145 @entity1 who improved, cost per QALY gained was acceptable at  62,175. However, for the 178 @entity1 with no gain or a loss in QALY, the economics are not reportable with a cost per QALY gained being theoretically infinite. Further studies are needed to identify specific @entity1 populations who will benefit from LESI because the economic viability of LESI requires improved @entity1 selection. LEVEL OF EVIDENCE: 2.
