Chuck Anderson, Adamowicz Wiktor, Jacobs Philip, Ohinmaa Arto, Dick Bruce, Rashiq Saifudin
Institute of Health Economics, Edmonton, AB, Canada.
Value Health. 2009 Jun;12(4):498-506. doi: 10.1111/j.1524-4733.2008.00457.x. Epub 2008 Sep 16.
We sought to identify chronic pain patients' preferences for levels of improvement in pain-related morbidity (PRM) by measuring their willingness to pay (WTP) for reducing their pain intensity and pain-related disability.
The study was a cross-sectional nonrandomized design. Participants were recruited from a tertiary multidisciplinary pain center in Canada. A computer-administered discrete-choice experiment was used to explore participants' WTP for various levels of improvement to PRM. Participants chose between two varying combination of treatments that differed in terms of their level of improvement in pain intensity, level of improvement in pain-related disability, and out-of-pocket monthly cost.
The WTP to completely minimize PRM was $1428 per month. Reduction in pain intensity was valued more highly than functional improvement. For every dollar, an individual was WTP to improve his/her disability to the lowest severity (mild), he/she was WTP approximately $2 to reduce pain intensity to moderate and $3 to reduce pain intensity to mild. The potential return on investment in terms of health improvement gained was $3318 per patient visit per year.
The morbidity associated with chronic pain is worth approximately $1428 for every month in the chronic pain health state. From the patient's perspective, treatment and management strategies that focus on reducing pain intensity would have the greatest impact on improving health-related quality of life. Valuing health improvement in monetary terms allows for direct monetary comparisons between the costs of chronic pain interventions and their associated health returns.
我们试图通过测量慢性疼痛患者为减轻疼痛强度和疼痛相关残疾而支付的意愿(WTP),来确定他们对疼痛相关发病率(PRM)改善水平的偏好。
该研究为横断面非随机设计。参与者从加拿大一家三级多学科疼痛中心招募。采用计算机管理的离散选择实验,探讨参与者对PRM不同改善水平的WTP。参与者在两种不同的治疗组合之间进行选择,这两种组合在疼痛强度改善水平、疼痛相关残疾改善水平和每月自付费用方面存在差异。
将PRM完全降至最低的WTP为每月1428美元。疼痛强度的降低比功能改善更受重视。对于每一美元,个人为将其残疾改善到最低严重程度(轻度)的WTP约为2美元,为将疼痛强度降低到中度的WTP约为2美元,为将疼痛强度降低到轻度的WTP约为3美元。每年每位患者就诊时,在健康改善方面的潜在投资回报率为3318美元。
在慢性疼痛健康状态下,与慢性疼痛相关的发病率每月价值约1428美元。从患者的角度来看,专注于减轻疼痛强度的治疗和管理策略对改善健康相关生活质量的影响最大。用货币来衡量健康改善情况,可以直接对慢性疼痛干预措施的成本与其相关的健康回报进行货币比较。