Epidural Steroid Injections Cut Spending for Low Back Pain

Pauline Anderson

February 20, 2016

PALM SPRINGS, California — Epidural steroid injections cut medical spending by 16.4% in some patients with low back pain, a new study suggests.

The award-winning research presented here at the American Academy of Pain Medicine (AAPM) 2016 Annual Meeting found that these injections, which have been shown to improve pain and disability in patients with low back pain, were associated with decreased total healthcare spending for patients with lumbago, radiculitis, and sciatica.

The decreases were largely driven by reductions in outpatient spending for things such as general practitioner visits and laboratory tests, said lead researcher Eric Sun, MD, PhD, instructor, Department of Anesthesiology, Stanford University, California.

Epidural steroid injections are increasingly being used for low back pain, but there is a concern that they are being overused, Dr Sun told Medscape Medical News.

"Low back pain affects a lot of people, and there are some growing questions. We're spending a lot of money treating it, and is that money well spent? What are we getting for all that we spend? Is it making people live more pain-free lives?"

The research used a national sample of privately insured patients from the Marketscan database. The database contains patient-level data on healthcare use across the inpatient, outpatient, and pharmacy settings, as well as information on amounts spent by the insurer.

The sample included 152,430 patients with radiculitis, 123,912 with sciatica, and 1,506,390 with lumbago, diagnosed between 2002 and 2011.

"We looked at people who got these steroid injections and tracked their costs over time, and we looked at people with back pain who didn't get these injections and tracked their costs over time, too," said Dr Sun.

Those not receiving injections were receiving normal medical management. None of the subjects in the study underwent surgery, which is relatively costly.

When most people get back pain, their costs "jump" within the first 90 days, whether or not they get steroid injections, but most of these patients get better, so their costs fall quickly, said Dr Sun. "What you find here is that the cost falls a lot faster with the people who got the epidural steroid injections. So that provides some evidence that it actually saves money."

Overall, the injections were associated with a 16.4% (P < .001) reduction in healthcare expenditures for patients with radiculitis over the course of 2 years. There were smaller but significant decreases for patients with sciatica (−7.56%; P < .001) and lumbago (−4.67%; P < .001).

Dr Sun called these savings "reasonable sums."

Subanalyses revealed that the decreases were primarily driven by reductions in outpatient spending. The injections were not associated with any cuts in pharmacy or inpatient spending.

Although he is not a pain specialist, Dr Sun said it is his understanding that epidural steroid injections are typically administered every 3 months.

Although this study found that epidural steroid injections are cost-effective, the evidence on whether they are effective in terms of improved pain scores is somewhat mixed, according to Dr Sun.

Dr Sun's poster was one of only four selected for a special showcase at the meeting.

Matthew Reed, MD, a pain medicine fellow from the University of California, Davis, who took time to read Dr Sun's poster, told Medscape Medical News he found the research "thought-provoking."

Epidural steroid injections, he said, are common procedures. "So seeing that you can impact actual costs would be an additional incentive to say 'good job; we're doing something that's valuable.' "

Although he has heard "contrasting views," this is the first time he has seen evidence that the injections are saving the healthcare system money, he said.

Dr Sun has disclosed no relevant financial relationships.

American Academy of Pain Medicine (AAPM) 2016 Annual Meeting: Poster 187. Presented February 19, 2016.

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