Abstract
Percutaneous epidural adhesiolysis ( PEA) is an alternative treatment for individuals suffering from chronic back pain due to lumbar spinal stenosis or those experiencing persistent pain after lumbar spine surgery or post- lumbar surgery syndrome, which does not respond to conventional treatment. Standard treatment usually includes the administration of steroid injections into the space above the outer spinal cord (Epidural steroid injection; ESI), a procedure commonly practiced today but still facing challenges in reimbursement from different health insurance schemes. Treating chronic low back pain stemming from spinal canal stenosis and addressing the pain persisting after lumbar spine surgery can significantly enhance a patient's quality of life, alleviate pain, and enable their return to normal activities. The procedure employs a catheter to disrupt the membrane, thus representing a viable treatment option. It also stands as a relatively new technology not yet established as a standard treatment in Thailand and comes with a high cost, rendering it financially burdensome for patients. Moreover, providing PEA procedures necessitates a prepared workforce, with services currently limited to hospitals in the Bangkok metropolitan area. Consequently, assessing the feasibility of delivering services involving PEA procedures is imperative. This study conducted a cost- utility analysis employing a Markov economic model. It compared the costs and outcomes of percutaneous epidural adhesiolysis; PEA, for treating chronic low back pain resulting from spinal epidural stenosis and post- lumbar surgery syndrome with standard treatment and the epidural steroid injection; ESI. Additionally, the study evaluated the budget impact analysis and feasibility analysis of the universal health coverage system over the next 5 years when incorporating PEA or ESI procedures into the benefits package. The findings of the cost- effectiveness study reveal that the PEA procedure is not costeffective in the Thai context compared to the ESI procedure and standard treatment. Similarly, when assessing the cost-effectiveness of the ESI procedure compared to standard treatment, it is also not cost-effective in the Thai context. Nonetheless, despite being not cost-effective and not fully aligned with Thailand's willingness to pay for the ESI procedure, it remains a long- standing and widely used procedure. It effectively alleviates pain, reduces suffering, and enhances the quality of life for patients experiencing persistent pain after lumbar spine surgery unresponsive to standard treatment. Furthermore, it serves as an option for pain relief in cases where patients are not yet prepared for surgery or in elderly individuals with narrowed spinal canals or patients experiencing persistent pain after lumbar spine surgery requiring repeated surgery (Re-operative). In conclusion, if either ESI or PEA procedures be included in the benefits package for patients with spinal stenosis and those with unresolved pain after lumbar spine surgery in Thailand, it should be noted that considering the ESI procedure alone for patients with spinal stenosis would result in a budget requirement of 1,098 million baht for the first year and approximately 22 million baht per year in subsequent years. Similarly, if only the ESI procedure is considered for patients expected to undergo the procedure due to post- lumbar surgery syndrome, the budget for the first year would amount to 46 million baht and approximately 5 million baht per year in subsequent years.
