title: Cost Utility Analysis of Percutaneous Adhesiolysis in Managing Pain of Post-lumbar Surgery Syndrome and Lumbar Central Spinal Stenosis.
abstract: BACKGROUND
  The increase in the number of interventions for the management of chronic pain and associated escalation of healthcare costs has captured the attention of health policymakers, in no small part due to the lack of documentation of efficacy, cost-effectiveness, or cost utility analysis. A recent cost utility analysis of caudal epidural injections in managing chronic low back pain of various pathologies showed a high cost utility with improvement in quality of life years, competitive with various other modalities of treatments. However, there are no analyses derived from high-quality controlled studies related to the cost utility of percutaneous adhesiolysis in the treatment of post-lumbar surgery syndrome or lumbar central spinal stenosis.
  
  
  METHODS
  This analysis is based on 2 previously published controlled studies.
  
  
  OBJECTIVE
  To assess the cost utility of percutaneous adhesiolysis procedures in managing chronic low back and lower extremity pain secondary to post-lumbar surgery syndrome and lumbar central spinal stenosis.
  
  
  METHODS
  A private, specialty referral interventional pain management center in the United States.
  
  
  METHODS
  Two controlled studies were conducted assessing the clinical effectiveness of percutaneous adhesiolysis for post-lumbar surgery syndrome and lumbar central spinal stenosis in an interventional pain management setting utilizing contemporary interventional pain management practices. A cost utility analysis was performed with direct payment data for a total of 130 patients in treatment groups over a 2-year period. Various outcome measures were included with significant improvement, defined as at least 50% improvement with reduction in pain and disability status.
  
  
  RESULTS
  The results of 2 controlled studies of low back pain with 60 and 70 patients and a 2-year follow-up with the actual reimbursement data showed cost utility for 1 year of quality-adjusted life year (QALY) of USD $2,652 for post-lumbar surgery syndrome and USD $2,649 for lumbar central spinal stenosis. The results of this assessment show that the cost utility of managing chronic, intractable low back pain with percutaneous adhesiolysis at a QALY that is similar or lower in price than medical therapy only, physical therapy, manipulation, spinal cord stimulation, and surgery.
  
  
  CONCLUSIONS
  The limitations of this cost utility analysis are that it is a single-center evaluation, with the inclusion of costs of adhesiolysis procedures in an ambulatory surgery center and physician visits, rather than all related costs including drug therapy and costs of disability in multiple settings.
  
  
  CONCLUSIONS
  This cost utility analysis of percutaneous adhesiolysis in the treatment of post-lumbar surgery syndrome and lumbar central spinal stenosis shows the clinical effectiveness and cost utility of these procedures at USD $2,650 per one year of QALY when performed in an ambulatory surgery center.
authors.affiliation: Pain Management Center of Paducah, Paducah, Kentucky, U.S.A.|Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, Kentucky, U.S.A.
authors.forename: Laxmaiah
authors.initials: L
authors.lastname: Manchikanti
authors.affiliation: Helm Center for Pain Management, Laguna Hills, California, U.S.A.
authors.forename: Standiford
authors.initials: S
authors.lastname: Helm
authors.affiliation: Pain Management Center of Paducah, Paducah, Kentucky, U.S.A.
authors.forename: Vidyasagar
authors.initials: V
authors.lastname: Pampati
authors.affiliation: Texas Tech University Health Sciences Center, Lubbock, Texas, U.S.A.
authors.forename: Gabor B
authors.initials: GB
authors.lastname: Racz
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis / Q000379:methods; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000191:economics* / Q000601:surgery; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000191:economics* / Q000379:methods; D010149:Postoperative Pain / Q000175:diagnosis / Q000191:economics*; D011788:Quality of Life; D013130:Spinal Stenosis / Q000175:diagnosis / Q000191:economics*; D013577:Syndrome; D014481:United States
keywords: chronic low back pain; cost utility analysis; cost-effectiveness analysis; lumbar central spinal stenosis; percutaneous adhesiolysis; post-lumbar surgery syndrome; quality-adjusted life years