PALM SPRINGS, Calif. — Epidural steroid injections (ESIs) may lower health care spending in patients with low back pain, according to research presented at the 32nd Annual Meeting of the American Academy of Pain Medicine (AAPM). The decreases appear to be largely driven by reductions in outpatient spending.
“Although ESIs have been shown to improve pain and disability scores for patients with low back pain, whether they reduce health care spending is unclear,” the authors wrote. According to lead study author Eric Sun, MD, PhD, instructor at Stanford University, the question of how ESIs affect costs was driven by the impression that the injections may be overused in clinical practice.
“They do improve pain for certain conditions,” Dr Sun said in a statement. “But when it comes time for insurance companies to cover something, they want to know if it saves money.”
In order to address the policy of reimbursement as a counterpart to studies that have shown some clinical benefit of ESIs with select diagnoses, the researchers used de-identified patient data to perform a retrospective analysis of administrative claims data from Truven Health Analytics Marketscan databases. The patients were diagnosed with low back pain between 2002 and 2011, and of the patients whose records were reviewed, 152 430 had radiculitis, 123 912 had sciatica, and 1 506 390 had lumbago.
The researchers found that ESIs were associated with a 16.4% overall reduction in health care expenditures for patients with radiculitis over 2 years, a 7.56% reduction in costs for patients with sciatica, and a 4.67% reduction in costs for patients with lumbago. ESIs were not associated with any reductions in pharmacy or inpatient spending, but outpatient spending was reduced 24.3% for patients with radiculitis, 12.7% for patients with sciatica, and 14.1% for patients with lumbago.
According to Dr Sun, the researchers attempted to eliminate as many confounders as possible, including the primary one being that many patients with low back pain tend to get better on their own. “We tried to look at people who get better and those who don’t, before and after their diagnosis of pain, and before and after ESI,” he said, adding that the drop in health care spending was much steeper following ESI. “That drop is bigger than you would expect from Father Time alone.”
Sun E, Darnall B, Baker L, Mackey S. Abstract #187. Do Epidural Steroid Injections Reduce Healthcare Spending for Patients with Low Back Pain? Evidence from the Marketscan® Database. Presented at: AAPM 2016. February 18-21, 2016; Palm Springs, California.