Impact of Age on the Cost-Effectiveness of Facet and Sacral Epidural Blocks

Objective: To evaluate the cost-effectiveness of combining sacral epidural block with foraminal block in the treatment of degenerative lumbar spine diseases and compare it with patient age. Materials and Methods: This is a retrospective cohort study. A total of 47 patients with degenerative lumbar spine disease associated with radiating leg pain were included. Low back pain and leg pain were assessed using the visual analog scale (VAS), applied during the consultation before the procedure and one week after. Data were compared preand postoperatively using the paired Student’s t-test. Cost-effectiveness and the cost required for a one-point improvement in VAS to age were calculated using the sum, division, and the rule of three. For inferential analysis, the paired Welch’s t-test with Bootstrap and the robust median test were used. Results: For low back pain, scores ranged from 2 to 10, with a mean of 7.5±2.14 (95% CI: 6.8-8.1) before the procedure, and from 0 to 10, with a mean of 3.1±2.8 (95% CI: 2.3-4.0) one week after (p<0.0001). For leg pain, scores ranged from 1 to 10, with a mean of 6.8±2.5 (95% CI: 6.1-7.4) before the intervention, and from 0 to 9, with a mean of 2.4±2.5 (95% CI: 1.8-3.1) one week after (p<0.0001). The cost of materials used for each procedure was 214.72 reais. Patients over 60 years old showed better cost-effectiveness compared to younger patients in lumbar infiltrations, with Welch’s t-test with Bootstrap 56.0 [21.5;90.2] (p=0.006). Regarding leg pain, there was no significant difference, with Welch’s t-test with Bootstrap -32.4 [-70.9;7.00] (p=0.12). Conclusion: The combination of sacral epidural block and foraminal block in patients over 60 years old for lumbar pain demonstrated better cost-effectiveness, while for leg pain, there was no significant difference in the cost-effectiveness of the procedure. Level of Evidence III; Retrospective Cohort Study.