Supporting the Physiatrist, Strengthening the Specialty

The Washington State Health Technology Assessment (HTA) has chosen to re-review spinal injection coverage policies. The evidence vendor, Spectrum Research, has completed its draft report, that states there is low-quality evidence to support the entire field of spinal injections. 
 
On March 18, the 11 HTA Clinical Committee members (HTCC) will meet to hear Spectrum’s report and listen to public comments before making coverage decisions. These policies affect patients with Medicaid, Labor & Industries, and state employees (PEBB). The decisions made by HTCC may have future impact on all payors and the VA system. In 2011, coverage for all procedures except facet steroid injections was maintained due to the large showing at the meeting.
 
We are seeking your help to ensure that coverage for spinal injections is maintained. If you are able to offer assistance with any of the request below, please reply to htaspine@gmail.com.

1. Are you willing to attend the HTCC meeting?

  When: Friday, March 18, 2016 at Noon (4 ­– 5 hours)

  Where: The Conference Center at Seattle-Tacoma International Airport

      South End, Main Terminal Building

      17801 International Blvd. (Pacific Highway S.)

      Seattle, WA 98158

1. Would you be willing to request speaking time? You must be present at the meeting to donate your time.

1. Are you aware of any media or political contacts that could help our efforts?

1. Do you have suggestions or comments regarding our rebuttal arguments? 

Your Academy, as a part of the Multi-society Pain Workgroup (MPW), has supported multiple comments (see attached) in response to HTA. In brief, our concerns include:

1. The systematic review of efficacy was limited to RCTs rather than thebest availableevidence.    
2. High-quality prospective studies were not included (e.g. Kennedy, Buker, Liliang, Maugers). 
3. The assigned “Strength of Evidence” appears to have not weighted high-quality RCT studies fairly as opposed to low quality RCTs (e.g. heterogenous inclusion criteria, non-fluoroscopic guidance, outcomes measures).
4. Limited analysis of categorical data rather than mean data. 
5. Limited subgroup analysis (e.g. ESI approach).
6. Lack of a peer-review process and limited utilization of designated “literature experts”.
7. The scope of re-review should have been limited to ESI for lumbar central stenosis with neurogenic claudication, and transforaminal use of particulate steroids, as the review was initiated because of the LESS trial and FDA concerns for ESI.  There is not substantiative new evidence since 2011 on other topics.
8. The review has limited consideration for the context of spinal injections as compared to other treatment options and their evidence.

Warm regards and thank you in advance for your assistance with this matter. 

The Washington State Health Technology Assessment (HTA) has chosen to re-review spinal injection coverage policies. The evidence vendor, Spectrum Research, has completed its draft report, that states there is low-quality evidence to support the entire field of spinal injections. 
 
On March 18, the 11 HTA Clinical Committee members (HTCC) will meet to hear Spectrum’s report and listen to public comments before making coverage decisions. These policies affect patients with Medicaid, Labor & Industries, and state employees (PEBB). The decisions made by HTCC may have future impact on all payors and the VA system. In 2011, coverage for all procedures except facet steroid injections was maintained due to the large showing at the meeting.
 
We are seeking your help to ensure that coverage for spinal injections is maintained. If you are able to offer assistance with any of the request below, please reply to htaspine@gmail.com.

1. Are you willing to attend the HTCC meeting?

  When: Friday, March 18, 2016 at Noon (4 ­– 5 hours)

  Where: The Conference Center at Seattle-Tacoma International Airport

      South End, Main Terminal Building

      17801 International Blvd. (Pacific Highway S.)

      Seattle, WA 98158

1. Would you be willing to request speaking time? You must be present at the meeting to donate your time.

1. Are you aware of any media or political contacts that could help our efforts?

1. Do you have suggestions or comments regarding our rebuttal arguments? 

Your Academy, as a part of the Multi-society Pain Workgroup (MPW), has supported multiple comments (see attached) in response to HTA. In brief, our concerns include:

1. The systematic review of efficacy was limited to RCTs rather than thebest availableevidence.    
2. High-quality prospective studies were not included (e.g. Kennedy, Buker, Liliang, Maugers). 
3. The assigned “Strength of Evidence” appears to have not weighted high-quality RCT studies fairly as opposed to low quality RCTs (e.g. heterogenous inclusion criteria, non-fluoroscopic guidance, outcomes measures).
4. Limited analysis of categorical data rather than mean data. 
5. Limited subgroup analysis (e.g. ESI approach).
6. Lack of a peer-review process and limited utilization of designated “literature experts”.
7. The scope of re-review should have been limited to ESI for lumbar central stenosis with neurogenic claudication, and transforaminal use of particulate steroids, as the review was initiated because of the LESS trial and FDA concerns for ESI.  There is not substantiative new evidence since 2011 on other topics.
8. The review has limited consideration for the context of spinal injections as compared to other treatment options and their evidence.

Warm regards and thank you in advance for your assistance with this matter.