Abstract：
BACKGROUND: Chronic axial low back pain (CLBP) that is not responsive to medication management or physical therapy often requires significant clinical intervention. Several interventional pain management options exist, including a 60-day peripheral nerve stimulation (PNS) treatment. This economic evaluation investigated the potential for projected cost savings associated with prioritizing 60-day PNS treatment relative to a \'standard of care\' (SOC) approach (where patients do not have access to 60-day PNS).
METHODS: A decision tree (supervised machine learning) model tracked treatment progression across two hypothetical cohorts of US patients with CLBP in whom non-interventional options were ineffective (Cohort A: treatment starting with 60-day PNS followed by any additional interventional and surgical treatments versus Cohort B: standard of care interventional and surgical treatments without access to 60-day PNS). Treatment efficacy estimates were based on published success rates. Conditional on treatment failure, up to two additional interventions were considered within the 12-month time frame in both cohorts. SOC treatment options included epidural injection, radiofrequency ablation (RFA), basivertebral nerve ablation (BVNA), PNS permanent implant (PNS-PI), spinal cord stimulator (SCS) trial/implant, and spinal fusion surgery. Treatment choice probabilities in both cohort algorithms were based on clinician interviews. Costs were based on national Medicare reimbursement levels in the ambulatory surgery center (ASC) setting. Savings reflected the difference in projected costs between cohorts. A Monte Carlo simulation and sensitivity analyses were conducted to generate confidence intervals and identify important inputs.
RESULTS: The treatment algorithm which prioritized initial 60-day PNS treatment was projected to save $8056 (95% CI $6112-$9981) per patient during the first year of interventional treatment relative to the SOC approach.
CONCLUSIONS: Use of the 60-day PNS treatment as an initial interventional treatment in patients with CLBP may result in significant savings for Medicare. Projected savings may be even larger for commercial payers covering non-Medicare patients.
METHODS: A decision tree (supervised machine learning) model tracked treatment progression across two hypothetical cohorts of US patients with CLBP in whom non-interventional options were ineffective (Cohort A: treatment starting with 60-day PNS followed by any additional interventional and surgical treatments versus Cohort B: standard of care interventional and surgical treatments without access to 60-day PNS). Treatment efficacy estimates were based on published success rates. Conditional on treatment failure, up to two additional interventions were considered within the 12-month time frame in both cohorts. SOC treatment options included epidural injection, radiofrequency ablation (RFA), basivertebral nerve ablation (BVNA), PNS permanent implant (PNS-PI), spinal cord stimulator (SCS) trial/implant, and spinal fusion surgery. Treatment choice probabilities in both cohort algorithms were based on clinician interviews. Costs were based on national Medicare reimbursement levels in the ambulatory surgery center (ASC) setting. Savings reflected the difference in projected costs between cohorts. A Monte Carlo simulation and sensitivity analyses were conducted to generate confidence intervals and identify important inputs.
RESULTS: The treatment algorithm which prioritized initial 60-day PNS treatment was projected to save $8056 (95% CI $6112-$9981) per patient during the first year of interventional treatment relative to the SOC approach.
CONCLUSIONS: Use of the 60-day PNS treatment as an initial interventional treatment in patients with CLBP may result in significant savings for Medicare. Projected savings may be even larger for commercial payers covering non-Medicare patients.
摘要：
背景：对药物管理或物理治疗无反应的慢性轴向下腰痛（CLBP）通常需要大量的临床干预。存在几种介入性疼痛管理选择，包括60天的周围神经刺激（PNS）治疗。这项经济评估调查了与“标准护理”（SOC）方法（患者无法获得60天PNS）相比，优先考虑60天PNS治疗相关的预计成本节省的可能性。
方法：决策树（监督机器学习）模型跟踪了两个假设的美国CLBP患者队列的治疗进展，这些患者的非介入选择无效（队列A：从60天PNS开始的治疗，然后进行任何其他介入和手术治疗，而队列B：无法获得60天PNS的标准干预和手术治疗）。治疗功效估计基于已发表的成功率。以治疗失败为条件，在两个队列中,在12个月的时间范围内考虑了最多两项额外的干预措施.SOC治疗方案包括硬膜外注射，射频消融(RFA),基底神经消融（BVNA），PNS永久性植入物(PNS-PI),脊髓刺激器（SCS）试验/植入，和脊柱融合手术.两种队列算法中的治疗选择概率均基于临床医生访谈。费用基于门诊手术中心（ASC）设置的国家医疗保险报销水平。节余反映了队列之间预计成本的差异。进行了蒙特卡罗模拟和敏感性分析以生成置信区间并确定重要的输入。
结果：与SOC方法相比，在介入治疗的第一年中，优先考虑初始60天PNS治疗的治疗算法预计每位患者节省8056美元（95％CI$6112-$9981）。
结论：使用60天的PNS治疗作为CLBP患者的初始介入治疗可以为Medicare节省大量费用。对于涵盖非Medicare患者的商业付款人，预计节省的费用可能更大。
方法：决策树（监督机器学习）模型跟踪了两个假设的美国CLBP患者队列的治疗进展，这些患者的非介入选择无效（队列A：从60天PNS开始的治疗，然后进行任何其他介入和手术治疗，而队列B：无法获得60天PNS的标准干预和手术治疗）。治疗功效估计基于已发表的成功率。以治疗失败为条件，在两个队列中,在12个月的时间范围内考虑了最多两项额外的干预措施.SOC治疗方案包括硬膜外注射，射频消融(RFA),基底神经消融（BVNA），PNS永久性植入物(PNS-PI),脊髓刺激器（SCS）试验/植入，和脊柱融合手术.两种队列算法中的治疗选择概率均基于临床医生访谈。费用基于门诊手术中心（ASC）设置的国家医疗保险报销水平。节余反映了队列之间预计成本的差异。进行了蒙特卡罗模拟和敏感性分析以生成置信区间并确定重要的输入。
结果：与SOC方法相比，在介入治疗的第一年中，优先考虑初始60天PNS治疗的治疗算法预计每位患者节省8056美元（95％CI$6112-$9981）。
结论：使用60天的PNS治疗作为CLBP患者的初始介入治疗可以为Medicare节省大量费用。对于涵盖非Medicare患者的商业付款人，预计节省的费用可能更大。
