Group sessions of either mindfulness-based stress reduction (MBSR) or cognitive-behavioral therapy (CBT) provide cost-effective treatment for chronic low-back pain, according to new research supported by the National Center for Complementary and Integrative Health and published in the journal Spine. In addition, MBSR may offer substantial cost savings compared to usual care. Previous studies suggested that both MBSR and CBT may be effective for treating back pain, but the economic benefits of these interventions have been unclear.
Researchers from the RAND Corporation, Kaiser Permanente Washington Health Research Institute, and the University of Washington, Seattle, randomly assigned 342 adults with chronic low-back pain in an integrated health care system to receive MBSR and usual care, CBT and usual care, or usual care alone. MBSR and CBT were provided in weekly 2-hour group sessions for 8 weeks.
The researchers calculated societal cost effectiveness by adding the incremental health care costs and productivity losses over change in quality-adjusted life-years. They also calculated costs from the perspective of a health care plan (payer). Compared to usual care, MBSR reduced total societal costs by $724 per person, and reduced individual health care costs to the payer by $982. CBT did not result in cost savings—but was low in cost ($125 per patient to society and $495 to the payer more than the cost of usual care). Participants in the MBSR and CBT groups also showed an increase in health-related quality of life compared to usual care participants. Although the analysis of back-related health care costs showed that CBT did not reduce them compared to usual care (costs per CBT patient were $984 higher than for usual care patients), both interventions reduced non-back-related health care costs compared to usual care.
The researchers noted that these findings suggest that group-based MBSR, and to a lesser extent group-based CBT, may provide cost-effective treatment for chronic low-back pain for both health care system payers and society.
- Herman PM, Anderson ML, Sherman KJ, et al. Cost-effectiveness of mindfulness-based stress reduction vs cognitive behavioral therapy or usual care among adults with chronic low-back pain. Spine. 2017;42(20):1511-1520.