Cost-effectiveness of Mindfulness-based Stress Reduction Versus Cognitive Behavioral Therapy or Usual Care Among Adults With Chronic Low Back Pain

Published in: Spine, Volume 42, Issue 20 (October 2017), pages 1511-1520. doi: 10.1097/BRS.0000000000002344

Posted on RAND.org on January 31, 2018

by Patricia M. Herman, Melissa L. Anderson, Karen J. Sherman, Benjamin H. Balderson, Judith A. Turner, Daniel C. Cherkin

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Research Question

  1. What is the cost effectiveness of mindfulness-based stress reduction (MBSR) or cognitive behavioral therapy (CBT) in comparison to usual care for chronic lower back pain in a large, integrated healthcare system in Washington State?

Study Design

Economic evaluation alongside a randomized trial of cognitive-behavioral therapy (CBT) and mindfulness-based stress reduction (MBSR) versus usual care alone (UC) for chronic low back pain (CLBP). Objective.To determine 1-year cost-effectiveness of CBT and MBSR compared to 33 UC.

Summary of Background Data

CLBP is expensive in terms of healthcare costs and lost productivity. Mind-body interventions have been found effective for back pain, but their cost-effectiveness is unexplored.

Methods

A total of 342 adults in an integrated healthcare system with CLBP were randomized to receive MBSR (n = 116), CBT (n = 113), or UC (n = 113). CBT and MBSR were offered in 8-weekly 2-hour group sessions. Cost-effectiveness from the societal perspective was calculated as the incremental sum of healthcare costs and productivity losses over change in quality-adjusted life-years (QALYs). The payer perspective only included healthcare costs. This economic evaluation was limited to the 301 health plan members enrolled [greater than or equal to]180 days in the years pre-and postrandomization.

Results

Compared with UC, the mean incremental cost per participant to society of CBT was $125 (95% confidence interval, CI: -4103, 4307) and of MBSR was -$724 (CI: -4386, 2778) — that is, a net saving of $724. Incremental costs per participant to the health plan were $495 for CBT over UC and -$982 for MBSR, and incremental back-related costs per participant were $984 for CBT over UC and -$127 for MBSR. These costs (and cost savings) were associated with statistically significant gains in QALYs over UC: 0.041 (0.015, 0.067) for CBT and 0.034 (0.008, 0.060) for MBSR.

Conclusion

In this setting CBT and MBSR have high probabilities of being cost-effective, and MBSR may be cost saving, as compared with UC for adults with CLBP. These findings suggest that MBSR, and to a lesser extent CBT, may provide cost-effective treatment for CLBP for payers and society. Level of Evidence: 2

Key Findings

  • MBSR reduced costs to society by $724 per year in comparison to usual care, and reduced healthcare costs to payers by $982; it also increased participants' quality-adjusted life years (QALYs) by 0.034.
  • CBT did not reduce costs, but was not particularly expensive; it provided a larger QALY gain (0.041) than MBSR.
  • Even though CBT increased healthcare costs related specifically to lower back pain, both CBT and MBSR reduced overall (i.e., non-back related) healthcare costs in comparison to usual care.
  • Results are not generalizable outside the setting studied.

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