Cost-effectiveness of low-level heat wrap therapy for low back pain

Objectives: To evaluate the cost-effectiveness and budget impact of a new heat wrap therapy for low back pain compared to paracetamol and ibuprofen from the perspective of the UK National Health Service (NHS). Methods: We evaluated cost-effectiveness using data from a phase III trial comparing the three therapies in 371 patients aged 18 to 55 years presenting with acute uncomplicated low back pain. The primary effectiveness measure used was successful treatment, defined as both clinically meaningful pain relief and clinically meaningful reduction in disability. We conducted a simple evaluation using NHS prescription costs and a modeled extrapolation including the costs of further treatment and consultations for patients treated unsuccessfully or with adverse events. Uncertainty was addressed using nonparametric bootstrapping and sensitivity analyses. Results: Successful treatment was reported by 57% of patients treated with heat wrap therapy, 26% treated with paracetamol and 18% treated with ibuprofen (P < 0.05 for heat wrap vs. both other groups). NHS prescription cost per patient was estimated to be pound1.35 for heat wrap therapy, pound0.26 for paracetamol, and pound0.28 for ibuprofen and cost per successful treatment was pound3.52 for heat wrap therapy compared to paracetamol, and pound2.72 compared to ibuprofen. In the modeled extrapolation, NHS cost per patient was pound27.77 for heat wrap therapy, pound34.20 for paracetamol, and pound36.04 for ibuprofen. Sensitivity analyses indicated that the findings were robust to plausible changes in data and assumptions. Conclusions: Economic evaluation of this study suggests that the NHS cost of introducing heat wrap therapy in place of oral analgesics would be modest and heat wrap therapy might potentially reduce the total cost of managing episodes of lower back pain.