1. 2024;27;E761-E773Cost-Utility Analysis of Radiofrequency Ablation Among Facet Joint-Related Chronic Low Back Pain Patients in Thailand
   Cost Utility Analysis
   Manit Sittimart, MSc, Dimple Butani, MPH, Chittawan Poonsiri, PharmD, Manta Korakot, MSc, Manilung Nalongsack, MSc, Pornpan Chalermkitpanit, MD, Pramote Euasobhon, MD, Koravee Pasutharnchat, MD, Sasikaan Nimmaanrat, MD, Napatpaphan Kanjanapanang, MD, and Yot Teerawattananon, MD, PhD.

BACKGROUND: Radiofrequency ablation (RFA) is a common secondary treatment recommended for facet joint-related chronic low back pain (CLBP). However, Thailand still lacks sufficient evidence of RFA’s cost-effectiveness to support the decision to fund it.

OBJECTIVE: To conduct a comparative economic evaluation of RFA and conservative treatment for CLBP patients over 16-month and 28-month time horizons in Thailand.

STUDY DESIGN: A full economic evaluation encompassing measurements of both health utilities and health costs.  

SETTING: Data were collected from 3 university hospitals in Bangkok, Thailand: King Chulalongkorn Memorial Hospital, Siriraj Hospital, and Ramathibodi Hospital.

METHODS: The cost-utility analysis, which used the Markov model, was developed according to the Thai health technology assessment guidelines and compared RFA and the best supportive care from the societal perspective. In the study, the population consisted of patients who had endured low back pain for more than 3 months despite receiving conservative treatment. The results were presented as an incremental cost-effective ratio (ICER) in Thai Baht (THB)/quality-adjusted life year (QALY). Scenario and sensitivity analyses were conducted.

RESULTS: RFA was not cost-effective in Thailand when compared to conservative treatment, with a cost-effectiveness (CE) ratio of I$13,652 at all time horizons. The ICER of RFA was I$99,267 and I$52,380/QALY for the 16- and 28-month time horizons, respectively. In a scenario analysis in which RFA was repeated at 28 months and followed up to 52 months, the ICER was reduced to I$43,451. One-way sensitivity analysis showed that the ICER was most sensitive to the changes in utility parameters, the cost of RFA, and opportunity cost in the no-pain state.

LIMITATIONS: The study uses primary data to derive the utility value and determine the costs. However, the limitation includes a relatively small sample size and a short follow-up time for parameter inputs.

CONCLUSION: This study, the first economic evaluation of RFA for CLBP in Asia, showed that RFA was not cost-effective in Thailand. Price negotiation is recommended to make the intervention more cost-effective before it is included in the benefit package.

KEY WORDS: Low back pain, facet joint, radiofrequency ablation, cost-utility analysis, cost-effectiveness, low- and middle-income countries, quality-adjusted life year, Thailand