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

Discussion and Conclusion

This modeling exercise facilitates comparisons across interventions not directly compared in trials, using consistent outcome measures and after balancing the baseline mix of patients. One limitation is that, to reliably estimate participants' health states for model inclusion, we needed trials with large samples (n ≥50 per arm) that included variables used for health state prediction. This exercise reveals the need to measure subgroups in CLBP: patients with CLBP can have different outcomes by pain impact level, and baseline patient mix varies substantially across trials. In addition, since nonpharmacologic therapies for CLBP are generally offered as adjuncts to usual care, this exercise underscores the need to separately measure the effects of usual care so that the therapy's generalizable impacts can be determined.