Currently, the utilization of percutaneous epidural adhesiolysis (PEA) has emerged as an alternative treatment modality for patients suffering from refractory lower back pain attributed to spinal stenosis or post-lumbar surgery syndrome, unresponsive to standard therapeutic approaches, including epidural steroid injections (ESI). While PEA has provided an alternative option for patients suffering with lower back pain, it faces several challenges, particularly in terms of healthcare fee reimbursement, rendering it financially burdensome for patients. Additionally, the availability of PEA services is limited to hospitals located in the Bangkok metropolitan area and its environs, necessitating a careful examination of the feasibility of integrating PEA into the broader healthcare landscape.

In light of these circumstances, the Health Intervention and Technology Assessment Program (HITAP) has been entrusted by the Health Systems Research Institute (HSRI) to undertake a research endeavor aimed at assessing the economic evaluation, budget impact, and feasibility analysis of implementing PEA in patients with spinal stenosis and post-lumbar surgery syndrome, covered by the comprehensive universal health coverage system. This study seeks to conduct a comprehensive cost-effectiveness analysis employing the Markov economic model to compare the costs and outcomes associated with PEA and ESI in the management of chronic, debilitating lower back pain arising from spinal stenosis and post-lumbar surgery syndrome. Furthermore, it aims to assess the potential budgetary impact on the universal health coverage system over a five-year time horizon, taking into consideration the inclusion of PEA or ESI within the benefit package.

By conducting a rigorous evaluation of the economic implications and clinical outcomes associated with PEA, this research endeavor intends to provide valuable insights into the feasibility and value of PEA as an alternative therapeutic option for patients with refractory lower back pain. Moreover, it aims to shed light on the financial considerations and potential impact on the healthcare system that would arise from the integration of PEA into the benefit package. Ultimately, the findings of this study have the potential to inform policy decisions and healthcare resource allocation, enabling a more evidence-based and equitable approach to the provision of care for patients suffering from spinal stenosis and post-lumbar surgery syndrome.