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Cost-effectiveness of Lumbar Epidural Steroid Injections

Carreon, Leah Y., MD, MSc; Bratcher, Kelly R., RN, CCRP; Ammous, Farah, MPH; Glassman, Steven D., MD

doi: 10.1097/BRS.0000000000000989

Study Design. Longitudinal cohort.

Objective. To determine the cost per quality-adjusted life-year for lumbar epidural steroid injections (LESI).

Summary of Background Data. Despite being a widely performed procedure, there are few studies evaluating the cost-effectiveness of LESIs.

Methods. Patients who had received LESI between June 2012 and July 2013 with EuroQOL-5D (EQ-5D) scores available before and after LESIs but before any surgical intervention were identified. Costs were calculated on the basis of the Medicare Fee Schedule multiplied by the number of LESIs received between the 2 clinic visits. Quality-adjusted life-years (QALYs) were calculated using the EQ-5D.

Results. Of 421 patients who had pre-LESI EQ-5D data, 323 (77%) had post-LESI data available; 200 females, 123 males, mean age: 59.2 ± 14.2 years. Cost per LESI was $608, with most patients receiving 3 LESIs for more than 1 year (range: 1–6 yr). Mean QALY gained was 0.005. One hundred forty-five patients (45%) had a QALY gain (mean = 0.117) at a cost of $62,175 per QALY gained; 127 patients (40%) had a loss in QALY (mean = −0.120) and 51 patients (15%) had no change in QALY. Fourteen of the 145 patients who improved, and 29 of the 178 patients who did not, have medical comorbidities that precluded surgery. Thirty-two (22%) of 131 patients without medical comorbidities who improved and 57 (32%) of 149 patients without medical comorbidities who did not improve subsequently had undergone surgery (P = 0.015).

Conclusion. LESI may not be cost-effective in patients with lumbar degenerative disorders. For the 145 patients who improved, cost per QALY gained was acceptable at $62,175. However, for the 178 patients with no gain or a loss in QALY, the economics are not reportable with a cost per QALY gained being theoretically infinite. Further studies are needed to identify specific patient populations who will benefit from LESI because the economic viability of LESI requires improved patient selection.

Level of Evidence: 2

Norton Leatherman Spine Center, Louisville, KY.

Address correspondence and reprint requests to Leah Y. Carreon, MD, MSc, Norton Leatherman Spine Center, 210 East Gray St, Ste 900, Louisville, KY 40202; E-mail:

Received 18 July, 2014

Revised 1 December, 2014

Accepted 2 December, 2014

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

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, consultancy, employment, grants, travel/accommodations/meeting expenses, patents, royalties.

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