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

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 Jan 31, 2018

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

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.


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.


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.


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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