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Evaluation of Cost-Utility of Thoracic Interlaminar Epidural Injections.
Current Pain and Headache Reports ( IF 3.7 ) Pub Date : 2020-01-30 , DOI: 10.1007/s11916-020-0838-1
Laxmaiah Manchikanti 1, 2, 3, 4 , Vidyasagar Pampati 4 , Satya P Sanapati 5 , Mahendra R Sanapati 6 , Alan D Kaye 7 , Joshua A Hirsch 8
Affiliation  

Purpose of Review

Chronic thoracic pain, even though not as prevalent as low back and neck pain, appears in approximately 30% of the general population. The severity of thoracic pain and degree of disability seems to be similar to other painful conditions. Despite this severity, interventions in managing chronic thoracic pain are less frequent, and there is a paucity of literature regarding epidural injections and facet joint interventions.

Recent Findings

As with lumbar and cervical spine, a multitude of interventions are offered in managing chronic thoracic pain, including interventional techniques with epidural injections and facet joint interventions. A single randomized controlled trial (RCT) has been published with a 2-year follow-up of clinical effectiveness of the results. However, there have not been any cost-utility analysis studies pertaining to either epidural injections or facet joint interventions in thoracic pain. Based on the results of the RCT, a cost-utility analysis of thoracic interlaminar epidural injections was undertaken.

Summary

Evaluation of the cost-utility analysis of thoracic interlaminar epidural injections with or without steroids in managing thoracic disc herniation, thoracic spinal stenosis, and thoracic discogenic or axial pain was assessed in 110 patients with a 2-year follow-up. Direct payment data from 2018 was utilized for procedural costs and indirect costs. Costs, including drug costs, were determined by multiplication of direct procedural payment data by a factor of 1.67 or addition of 40% of cost to accommodate for indirect payments and arrive at overall costs. Cost-utility analysis showed direct procedural cost of USD $1943.19, whereas total estimated costs year per QALY were USD $3245.12.


中文翻译:

胸膜间硬膜外注射的成本-效用评估。

审查目的

慢性胸痛虽然不如腰背痛和颈痛那么普遍,但约占总人口的30%。胸痛的严重程度和残疾程度似乎与其他疼痛情况相似。尽管有这种严重性,用于控制慢性胸痛的干预措施仍较不频繁,并且关于硬膜外注射和小关节治疗的文献很少。

最近的发现

与腰椎和颈椎一样,可提供多种干预措施来治疗慢性胸痛,包括采用硬膜外注射和多关节联合干预的干预技术。已经发表了一项随机对照试验(RCT),并对结果的临床有效性进行了为期2年的随访。但是,还没有任何关于硬膜外注射或小关节疼痛的胸痛联合干预的成本效用分析研究。基于RCT的结果,对胸膜层间硬膜外注射进行了成本-效用分析。

概要

评估了110例接受2年随访的患者的胸膜间硬膜外注射有无类固醇激素治疗胸椎间盘突出症,胸椎管狭窄和胸椎椎间盘源性或轴向性疼痛的成本效益分析。2018年的直接付款数据用于程序成本和间接成本。费用(包括药品费用)是通过将直接程序付款数据乘以1.67或乘以40%的费用以适应间接付款并得出总体费用来确定的。成本效用分析显示,直接程序成本为1943.19美元,而每个QALY的年度估计总成本为3245.12美元。
更新日期:2020-01-30
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