SUBJECT: ICER Scoping Document on Certain Non-pharmacologic Interventions for
Chronic Low Back and Neck Pain
Dear Colleagues:
The American Association of Neurological Surgeons (AANS), Congress of Neurological Surgeons (CNS)
and the AANS/CNS Joint Section on the Disorders of the Spine and Peripheral Nerves (AANS/CNS
DSPN) appreciate the opportunity to review the scoping document prepared by the Institute for Clinical
and Economic Review (ICER). This paper is intended to inform the California Technology Assessment
Forum’s (CTAF) consideration of coverage policy for certain non-pharmacologic interventions for
chronic low back and neck pain.
The scoping document reports in the background section the estimated costs of back and neck pain in the
United States was $88 billion in 2013. The report further states that the costs for the management of these
entities have increased faster than any other group of diagnoses (from 30.4 billion in 1996 to 87.6 billion
in 2013). We are concerned that there is no stratification of the costs associated with the various therapies
— surgical, injection therapy, physical therapy, etc. We believe that it is essential to identify that the
increase in costs is not related to surgical intervention, but rather various nonoperative forms of
intervention.
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