Abstract ID: 3859

Primary Topic: Mind-body (including meditation and yoga)
Secondary Topic: Health Services Research/Cost Effectiveness

Cost-Effectiveness of Mindfulness Based Stress Reduction versus Cognitive behavioral Therapy versus Usual Care for Chronic Low Back Pain
Patricia M. Herman, ND, PhD, RAND Corporation, Santa Monica, CA, United States; Melissa L Anderson, MS, Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States; Karen Sherman, PhD MPH, Kaiser Permanente , Seattle, WA, United States; Benjamin H Balderson, PhD, Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States; Judith A Turner, PhD, University of Washington, Seattle, WA, United States; Daniel C Cherkin, PhD, Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States

Late Breaker: No

Purpose

Chronic low-back pain (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. The purpose of this study was to determine the cost-effectiveness of two mind-body interventions, cognitive behavioral therapy (CBT) and mindfulness-based stress reduction (MBSR) for CLBP.

Methods/Session Format

Economic evaluation alongside a one-year randomized trial of CBT and MBSR versus usual care alone (UC) for patients with low-back pain of >3 months duration. Three hundred forty-two adults in an integrated healthcare system in Washington State with CLBP were randomly assigned 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.  

Patricia Herman will be the only speaker.

Results

This economic evaluation was limited to the 301 health plan members enrolled for at least 180 days in the years pre-and post-randomization. The mean incremental cost per participant to society of CBT over UC was $125 (95% CI: -4103, 4307) and of MBSR was -$724 (CI: -4386, 2778)—i.e., a net saving of $724 compared to UC. 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 significant gains in QALYs over UC: 0.041 (0.015, 0.067) for CBT and 0.034 (0.008, 0.060) for MBSR.

Conclusions

In this setting CBT and MBSR have high probabilities of being cost-effective, and MBSR may be cost saving, as compared to 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.