ICER Evaluates Cost-Effectiveness of Cognitive Therapies for Chronic Pain

A new draft report from the Institute for Clinical and Economic Review (ICER) indicates that cognitive and mind-body therapies may be valuable additions to usual care for chronic back and neck pain, but that more evidence is needed to understand the cost-effectiveness implications for both conditions.

The draft evidence report from ICER explains that chronic neck and back pain are common ailments responsible for over $87 billion in total spending in the United States as of 2013. They are treated with a wide array of therapies, including pharmaceutical treatments, physical therapy, and mind-body treatments.

Report authors explained that mind-body treatments are less commonly prescribed than the other noninvasive therapies, which could be due to a lack of knowledge about the value and effectiveness of these therapies, barriers to access, or insurer policies regarding coverage.

Noting that chronic pain can be exacerbated by cognitive factors, the researchers wrote that they “thought it timely to evaluate evidence on the effectiveness of cognitive and mind-body therapies for chronic low back and neck pain.”

Therefore, the report aims to quantify the effect of 5 mind-body therapies—yoga, tai chi, cognitive behavioral therapy (CBT), mindfulness-based stress reduction, and acupuncture—on outcomes in chronic neck and back pain.

A review of coverage policies indicated that some plans offer CBT under their behavioral health benefits and that some wellness-focused insurers cover acupuncture, but coverage of the other therapies was sporadic at best.

Next, a literature review found that there were small health benefits associated with each of the 5 interventions when added to usual care for chronic low back pain, but the benefits for neck pain were smaller or unknown.

The researchers then conducted cost-effectiveness analyses for chronic low back pain only, since there was not sufficient evidence published regarding chronic neck pain. They determined that the quality-adjusted life year (QALY) gains for the mind-body interventions were small compared with usual care.

“Among the five interventions, the incremental cost of achieving one case of improved pain over the five-year time horizon relative to usual care ranged from approximately $6,200 for tai chi to approximately $15,800 for CBT,” the report authors wrote. “The cost per additional QALY ranged from approximately $58,000 for yoga to approximately $156,000 for CBT over a five-year time horizon.”

ICER will now accept public comments on the draft until September 12. Its final evidence report will incorporate these comments and will include value-based benchmark prices for the treatments.