Nerve Ablation May Be a Cost-Effective Treatment for Vertebrogenic Chronic Lower Back Pain

Intraosseous basivertebral nerve ablation (BVNA) is a cost-effective and clinically effective treatment for people with vertebrogenic chronic lower back pain (cLBP) compared with standard care alone, according to results of an economic analysis published in Spine. The findings suggest that BVNA performed using the Intracept Procedure (Boston Scientific, Marlborough, MA), a minimally invasive and implant-free surgery, may have cost benefits for the healthcare system, clinicians, and people with vertebrogenic cLBP.

The published findings result from an economic analysis using data from the INTRACEPT (NCT03246061) and SMART (NCT01446419) clinical studies. INTRACEPT was a parallel group, multicenter, open-label randomized controlled trial (RCT) that included 140 people with vertebrogenic cLBP who were randomized 1:1 to receive either BVNA or continuation of standard care. The primary endpoint was difference in disability between the 2 groups according to least squared mean change in Oswestry Disability Index (ODI).

SMART was a randomized, blinded, sham-controlled, multicenter, international study evaluating the safety and efficacy of BVNA, in which 225 participants were randomized 2:1 to receive either BVNA or sham treatment. The primary endpoint was change from baseline to 3 months posttreatment in ODI.

In the economic analysis of these 2 studies, researchers developed a cost-effectiveness model to evaluate health outcomes and costs for the participants who received BVNA with additional analyses performed to analyze the robustness of the model’s results.

• At a 5-year time horizon, BVNA was associated with a 1.103 gain in quality-adjusted life years (QALYs).
• There was an estimated incremental cost-effectiveness ratio (ICER) of $11,376 for each QALY gained.
• Modeling demonstrated a >99% probability that BNA was cost effective in the United States based on a $100,000 willingness-to-pay threshold.