Update of Markov Model on the Cost-Effectiveness of Nonpharmacologic Interventions for Chronic Low Back Pain Compared to Usual Care

Patricia M. Herman, ND, PhD; Ryan K. McBain, PhD; Nicholas Broten, MS; Ian D. Coulter, PhD


Spine. 2020;45(19):1383-1385. 

In This Article


The Markov model used transition probabilities to move a hypothetical cohort of patients between four defined health states every 6 weeks for just over a year. The health states were: high-impact chronic pain (individuals with substantial activity limitations), moderate-impact chronic pain (mild activity limitations but higher pain), low-impact chronic pain (mild activity limitations with lower pain), and a healthy, no pain state. Transition probabilities between health states were estimated for each intervention using patient-level data from each trial. As CLBP patients moved through the model, they accumulated quality-adjusted life-years (QALYs)[7] and healthcare[8] and productivity costs.[7] Incremental costs and effects for each therapy were calculated net of each study's version of usual care.