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.
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DOI：
10.1097/brs.0000000000002344
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发表时间：
2017-10-15
期刊：
影响因子：
3
通讯作者：
Cherkin DC
中科院分区：
文献类型：
--
作者：
Herman PM;Anderson ML;Sherman KJ;Balderson BH;Turner JA;Cherkin DC
经济学评估以及认知行为疗法（CBT）和基于正念的减压（MBSR）与常规护理（UC）治疗慢性腰痛（CLBP）的随机试验。确定CBT和MBSR与UC相比的一年成本效益。就医疗保健成本和生产力损失而言，CLBP的成本很高。身心干预已被发现对背痛有效，但其成本效益尚未探讨。在一个综合医疗保健系统中，342名患有CLBP的成年人被随机分配接受MBSR（n = 116），CBT（n = 113）或UC（n = 113）。CBT和MBSR在8个每周2小时的小组会议中提供。从社会的角度来看，成本效益计算为医疗保健成本和生产力损失随质量调整生命年（QHRs）变化的增量总和。支付者的角度只包括医疗费用。该经济评价仅限于随机化前后入组≥ 180天的301名健康计划成员。与UC相比，CBT的每名参与者对社会的平均增量成本为125美元（95% CI：-4103，4307），MBSR为-724美元（CI：-4386，2778）-即，净节省724美元。健康计划的每名参与者的增量成本为CBT超过UC 495美元，MBSR为-982美元，CBT超过UC的每名参与者的增量相关成本为984美元，MBSR为-127美元。这些成本（和成本节约）与QBOS相对于UC的统计学显著收益相关：CBT为0.041（0.015，0.067），MBSR为0.034（0.008，0.060）。在这种情况下，CBT和MBSR具有很高的成本效益概率，与CLBP成人UC相比，MBSR可能节省成本。这些研究结果表明，正念减压疗法，以及在较小程度上的CBT，可以为支付者和社会提供成本效益高的CLBP治疗。
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). Determine the one-year cost-effectiveness of CBT and MBSR compared to UC. 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. 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 >=180 days in the years pre-and post-randomization. Compared to UC, the mean incremental cost per participant to society of CBT was $125 (95% CI: −4103, 4307) and of MBSR was −$724 (CI: −4386, 2778)—i.e., 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 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.