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Cost-effectiveness of Mindfulness-based Stress Reduction Versus Cognitive Behavioral Therapy or Usual Care Among Adults With Chronic Low Back Pain

Herman, Patricia M. ND, PhD*; Anderson, Melissa L. MS; Sherman, Karen J. PhD†,‡; Balderson, Benjamin H. PhD; Turner, Judith A. PhD§,¶; Cherkin, Daniel C. PhD†,||,**

doi: 10.1097/BRS.0000000000002344
Randomized Trial

Study Design. 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).

Objective. To determine 1-year cost-effectiveness of CBT and MBSR compared to 33 UC.

Summary of Background Data. 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.

Methods. A total of 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 postrandomization.

Results. Compared with UC, the mean incremental cost per participant to society of CBT was $125 (95% confidence interval, CI: −4103, 4307) and of MBSR was −$724 (CI: −4386, 2778)—that is, 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.

Conclusion. In this setting CBT and MBSR have high probabilities of being cost-effective, and MBSR may be cost saving, as compared with 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.

Level of Evidence: 2

*RAND Corporation, Santa Monica, CA

Kaiser Permanente Washington Health Research Institute, Seattle, WA

Department of Epidemiology, University of Washington, Seattle, WA

§Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA

Department of Rehabilitation Medicine, University of Washington, Seattle, WA

||Department of Health Services, University of Washington, Seattle, WA

**Department of Family Medicine, University of Washington, Seattle, WA.

Address correspondence and reprint requests to Patricia M. Herman, ND, PhD, RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138; E-mail:

Received 22 February, 2017

Revised 30 April, 2017

Accepted 11 July, 2017

The manuscript submitted does not contain information about medical device(s)/drug(s).

The National Center for Complementary and Integrative Health (NICCIH) of the National Institutes of Health (NIH) (award number R01AT006226) funds were received in support of this work.

Relevant financial activities outside the submitted work: grants.

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