– Publically available report will be part of initiative of Boston-area employer coalition to improve quality and reduce the costs of care –
Boston, Mass., June 24, 2011 – A comprehensive appraisal of management options for patients with low back disorders was released today by the Institute for Clinical and Economic Review (ICER), a leader in comparative effectiveness research based at the Massachusetts General Hospital’s Institute for Technology Assessment. The report includes evaluations of the comparative clinical effectiveness and cost-effectiveness of various treatment strategies, and will be used by the Employers Action Coalition on Healthcare (EACH), an employer coalition in Massachusetts, as the foundation of efforts to work with health insurers and provider groups to improve quality while reducing the costs of care for this common condition.
“Clinicians have struggled for decades to effectively help patients with various types of low back disorders, all of which can severely affect patients’ quality of life, not to mention the impact on productivity at work and on associated medical care costs,” said Steven Pearson, MD, ICER’s President. “Our report will help physicians, patients and policymakers understand what the latest evidence is on the relative effectiveness of interdisciplinary rehabilitation programs, injections, minimally-invasive procedures, and surgical approaches to managing this common problem.”
Low back pain is an exceedingly common complaint—nearly every adult has at least one episode of low back pain at some point. It is the fifth most common reason for all physician visits in the U.S. and is responsible for direct medical costs that approach $30 billion annually.
ICER’s research assessed the evidence on several management options for four distinct patient conditions: lumbar disc herniation, lumbar spinal stenosis, degenerative spondylolisthesis and non-specific low back pain. Management options of interest included: surgery (discectomy, laminectomy, spinal fusion, interspinous spacer systems); minimally-invasive procedures (intradiscal electrothermal therapy, coblation nucleoplasty, radiofrequency denervation); multiple types of spinal injections, and interdisciplinary rehabilitation programs.
ICER’s appraisal concluded that the evidence on spinal injections and minimally-invasive procedures was either insufficient to be able to make a reasonable comparison with conservative treatment, or at best suggested that there was no additional clinical benefit over conservative treatment for most patients. Published evidence does demonstrate that surgery for patients with lumbar disc herniation and spinal stenosis can provide earlier improvements in pain and restoration of function than conservative care, but these early advantages often diminish over 1-2 years. For those patients with more common forms of non-specific low back pain, evidence from randomized controlled trials shows that surgery provides no additional benefit in pain or function compared with conservative care, while presenting a low but real risk of complications. The lack of evidence on long-term benefit is important to consider in analyses of cost-effectiveness, as some surgical procedures for low back pain are quite costly.
The ICER analysis also attempted to evaluate which components of an interdisciplinary rehabilitation program may be associated with positive results compared to simple conservative care. Use of interdisciplinary rehabilitation programs has been growing, but review of the available published evidence indicates that complex rehabilitation programs do not usually produce better results when they are compared to high-quality physical therapy alone.
“Our report highlights the areas where there is a lack of quality evidence on the effectiveness of several strategies employed to manage patients with low back disorders,” said Dan Ollendorf, MPH, ICER’s Chief Review Officer. “By conducting this comprehensive analysis, we hope that patients and clinicians will have more information at their disposal to make decisions about appropriate treatment approaches for low back pain, and to design new studies that capture the most relevant outcomes.”
The appraisal of low back disorders involved a comprehensive systematic review of the literature, the development of a simulation model to examine costs and cost-effectiveness, and consultation with a national evidence review group to inform the ICER team throughout the process. The full report and associated appendices with detailed information on the results of ICER’s work are available online. This final report will serve as the basis for a multi-stakeholder initiative with EACH to design and implement innovative approaches to improving the quality and value of care for low back pain patients. The project involves major purchasers, employers, healthcare providers and health plans in Massachusetts.
The Institute for Clinical and Economic Review (ICER), based at the Massachusetts General Hospital’s Institute for Technology Assessment (ITA) and an affiliate of Harvard Medical School, provides independent evaluation of the clinical effectiveness and comparative value of new and emerging technologies. Structured as a fully transparent organization, ICER seeks to achieve its ultimate mission of informing public policy and spurring innovation in the use of evidence to improve the value of health care for all. For more information, please visit www.icer-review.org.