Cost Utility Analysis of Percutaneous Adhesiolysis in Managing Pain of Post‐lumbar Surgery Syndrome and Lumbar Central Spinal Stenosis

Manchikanti, Laxmaiah; Helm, Standiford; Pampati, Vidyasagar; Racz, Gabor B.

doi:10.1111/papr.12195

Cited by 33 publications

(35 citation statements)

References 52 publications

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“…Cost effectiveness of interventional techniques has been demonstrated for spinal cord stimulation (531), percutaneous adhesiolysis (532), and caudal epidural injections (533) in chronic recalcitrant pain presenting to interventional pain management settings after failure of conservative modalities and often surgical interventions. Cost effectiveness of drug therapy modalities also has been demonstrated for various nonopioid drug treatments, often with clinically insignificant outcomes and higher costs than interventional therapies (518,(534)(535)(536)(537)(538)(539)(540)(541)(542)(543).…”

Section: Effectiveness Of Nonopioid Pharmacological and Nonpharmacolomentioning

confidence: 99%

“…Cost effectiveness of drug therapy modalities also has been demonstrated for various nonopioid drug treatments, often with clinically insignificant outcomes and higher costs than interventional therapies (518,(534)(535)(536)(537)(538)(539)(540)(541)(542)(543). A cost utility analysis showed caudal epidural injections to be effective at $2,172 for one year of qualityadjusted life year (QALY) (533), $2,650 for percutaneous adhesiolysis for one year of QALY (532), and (£) 6,392 for spinal cord stimulation for one year of QALY (531). In contrast, Wielage et al (537), in assessing cost effectiveness of various drugs in managing chronic low back pain with a U.S. private payer perspective, estimated an incremental cost-effectiveness ratio (ICER) of $59,473 for duloxetine over naproxen.…”

Section: Effectiveness Of Nonopioid Pharmacological and Nonpharmacolomentioning

confidence: 99%

“…However, these 2 opposing facts may be reconciled based on the fact that 70% of long-term opioid users were disabled or suffered from a handicap or chronic disease which kept them from participating fully in work, school, housework, or other activities. Consequently, clinical effectiveness, cost utility, and cost effectiveness studies have shown interventional therapies to be more economical than many of the drug therapies described in CDC guidelines (42), with interventional therapies showing clinically significant improvement utilizing criterion standards of > 50% improvement (487)(488)(489)(490)(491)(492)(493)(494)(495)(496)(499)(500)(501)(502)(503)(504)(505)(506)521,525,(531)(532)(533). Fifty-eight percent of the patients agreed that opioids are prescribed appropriately, 67% agreed that opioids are a preferred treatment, and an overwhelming 89% were worried that they would not be able to get opioid pain medication.…”

Section: Guidance For Responsible Opioid Prescribing For Chronic Non-mentioning

confidence: 99%

See 2 more Smart Citations

Responsible, Safe, and Effective Prescription of Opioids for Chronic Non-Cancer Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines

Kaye²,

et al. 2017

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Background: Opioid use, abuse, and adverse consequences, including death, have escalated at an alarming rate since the 1990s. In an attempt to control opioid abuse, numerous regulations and guidelines for responsible opioid prescribing have been developed by various organizations. However, the US opioid epidemic is continuing and drug dose deaths tripled during 1999 to 2015. Recent data show a continuing increase in deaths due to natural and semisynthetic opioids, a decline in methadone deaths, and an explosive increase in the rates of deaths involving other opioids, specifically heroin and illicit synthetic fentanyl. Contrary to scientific evidence of efficacy and negative recommendations, a significant proportion of physicians and patients (92%) believe that opioids reduce pain and a smaller proportion (57%) report better quality of life. In preparation of the current guidelines, we have focused on the means to reduce the abuse and diversion of opioids without jeopardizing access for those patients suffering from non-cancer pain who have an appropriate medical indication for opioid use. Objectives: To provide guidance for the prescription of opioids for the management of chronic non-cancer pain, to develop a consistent philosophy among the many diverse groups with an interest in opioid use as to how appropriately prescribe opioids, to improve the treatment of chronic non-cancer pain and to reduce the likelihood of drug abuse and diversion. These guidelines are intended to provide a systematic and standardized approach to this complex and difficult arena of practice, while recognizing that every clinical situation is unique. Methods: The methodology utilized included the development of objectives and key questions. The methodology also utilized trustworthy standards, appropriate disclosures of conflicts of interest, as well as a panel of experts from various specialties and groups. The literature pertaining to opioid use, abuse, effectiveness, and adverse consequences was reviewed, with a best evidence synthesis of the available literature, and utilized grading for recommendation as described by the Agency for Healthcare Research and Quality (AHRQ).

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Section: Effectiveness Of Nonopioid Pharmacological and Nonpharmacolomentioning

confidence: 99%

Section: Effectiveness Of Nonopioid Pharmacological and Nonpharmacolomentioning

confidence: 99%

Section: Guidance For Responsible Opioid Prescribing For Chronic Non-mentioning

confidence: 99%

See 1 more Smart Citation

Responsible, Safe, and Effective Prescription of Opioids for Chronic Non-Cancer Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines

Kaye²,

et al. 2017

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“…The cost utility for 1 year of quality-adjusted life year (QALY) of USD is $2,652 for post-lumbar surgery syndrome and USD $2,649 for lumbar central spinal stenosis [68].…”

Section: Discussionmentioning

confidence: 99%

Epidural Lysis of Adhesions and Percutaneous Neuroplasty

Racz

Heavner

Noe

et al. 2016

Techniques of Neurolysis

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“…Even prior to the proposed rule, interventional techniques have been facing a multitude of issues despite demonstration of clinical and cost effectiveness due to improper evidence synthesis (41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58). Based on the available data, CMS is proposing updated pricing recommendations for supply and equipment items currently used as direct practice expense (PE) inputs.…”

Section: Introductionmentioning

confidence: 99%

Reframing Medicare Physician Payment Policy for 2019: A Look at Proposed Policy

Manchikanti

Singh²,

Benyamin

et al. 2018

Pain Phys

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On July 12, 2018, the Centers for Medicare and Medicaid Services (CMS) released the proposed 2019 Medicare physician fee schedule and quality payment program, combining these 2 rules for the first time. This occurred in a milieu of changing regulations that have been challenging for interventional pain management specialists. The Affordable Care Act (ACA) continuous to be amended by multiple administrative changes. This July 12th rule proposes substantial payment changes for evaluation and management (E&M) services, with documentation requirements, and blending of Level II to V CPT codes for E&M into a single payment. In addition, various changes in the quality payment program with liberalization of some metrics have been published. Recognizing that there are differing impacts based on specialty and practice type, as a whole interventional pain management specialists would likely see favorable reimbursement trends for E&M services as a result of this proposal. Moreover, in comparison with recent CMS final ruling, this proposed rule has relatively limited changes in procedural reimbursement performed in a facility or in-office setting. CMS, in the new rule, has proposed an overhaul of the E&M documentation and coding system ostensibly to reduce the amount of time physicians are required to spend inputting information into patients’ records. The new proposed rule blends Level II to V codes for E&M services into a single payment of $93 for office outpatient visits for established patients and $135 for new patient visits. This will also have an effect with blended payments for services provided in hospital outpatients. CMS also has provided additional codes to increase the reimbursement when prolonged services are provided with total reimbursement coming to Level V payments. Interventional pain managementcentered care has been identified as a specialty with complexity inherent to E&M associated with these services. Among the procedural payments, there exist significant discrepancies for the services performed in hospitals, ambulatory surgery centers (ASCs), and offices. A particularly egregious example is peripheral neurolytic blocks, which is reimbursed at 1,800% higher in hospital outpatient department (HOPD) settings as compared with procedures done in the office. The majority of hospital based procedures have faced relatively small cuts as compared with office based practice. The only significant change noted is for spinal cord stimulator implant leads when performed in office setting with 19.2% increase. However, epidural codes, which have been initiated with a lower payment, continue to face small reductions for physician portion. This review describes the effects of the proposed policy on interventional pain management reimbursement for E&M services, procedural services by physicians and procedures performed in office settings. Key words: Physician payment policy, physician fee schedule, Medicare, Merit-Based Incentive Payment System, interventional pain management, regulatory tsunami, Medicare Access and CHIP Reauthorization Act of 2015

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Cost Utility Analysis of Percutaneous Adhesiolysis in Managing Pain of Post‐lumbar Surgery Syndrome and Lumbar Central Spinal Stenosis

Cited by 33 publications

References 52 publications

Responsible, Safe, and Effective Prescription of Opioids for Chronic Non-Cancer Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines

Responsible, Safe, and Effective Prescription of Opioids for Chronic Non-Cancer Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines

Epidural Lysis of Adhesions and Percutaneous Neuroplasty

Reframing Medicare Physician Payment Policy for 2019: A Look at Proposed Policy

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