Health Economics Research Unit, University of Aberdeen, Fosterhill Aberdeen AB25 2ZD, UK.
Clin J Pain. 2013 Apr;29(4):366-75. doi: 10.1097/AJP.0b013e318250f539.
To determine the cost-effectiveness of self-management techniques for older populations (65 and over) with chronic pain and in the absence of such evidence to investigate this question in an aging adult population (average age 60 and over).
Systematic review of randomized controlled trials (RCTs) with cost-effectiveness data and at least 6 months' follow-up, up to December 2010.
No RCT studies reported cost-effectiveness of self-management exclusively in the over 65 age group. Ten RCTs reported participants with an average age of 60 years or over and met all other inclusion criteria. All of these studies measured cost-effectiveness as cost per improvement in primary outcome, 7 of them using the Western Ontario and McMaster Universities Osteoarthritis Index score, of which 6 reported the pain dimension. Six studies reported cost per quality-adjusted life year (QALY)-gained information, with a further 1 reporting EQ-5D. In 7 studies, relative to usual care, self-management was effective, and in the remaining 3 studies, there was no significant difference. Among those reporting cost per QALY-gained results, self-management did not lead to statistically significant QALY gains relative to usual care (with only one exception). Eight studies suggested that the cost of developing and delivering self-management interventions may be partly offset by savings from reduced subsequent health care resource use.
Self-management is effective among an aging adult population (mean age over 60) with chronic pain and may be cost-effective when outcomes are measured using the Western Ontario and McMaster Universities Osteoarthritis Index pain score. Cost-effectiveness is less certain when measured using the QALY metric. Uncertainty over conclusions regarding cost-effectiveness exists partly due to lack of information regarding societal willingness to pay for pain improvement. There is a need for large multicentred high-quality RCTs to confirm the findings of this review exclusively among older aged populations, such as those who have already reached the statutory retirement age.
确定针对患有慢性疼痛的老年人群（65 岁及以上）的自我管理技术的成本效益，在缺乏此类证据的情况下，调查老龄化人群（平均年龄 60 岁及以上）中是否存在这一问题。
对截至 2010 年 12 月具有成本效益数据和至少 6 个月随访结果的随机对照试验（RCT）进行系统评价。
没有 RCT 研究专门报告 65 岁以上人群自我管理的成本效益。10 项 RCT 报告了平均年龄在 60 岁或以上且符合所有其他纳入标准的参与者。所有这些研究都将成本效益衡量为主要结果改善的每单位成本，其中 7 项使用了西安大略和麦克马斯特大学骨关节炎指数评分，其中 6 项报告了疼痛维度。有 6 项研究报告了每获得一个质量调整生命年（QALY）的成本信息，另有 1 项报告了 EQ-5D。在 7 项研究中，与常规护理相比，自我管理是有效的，而在其余 3 项研究中，没有显著差异。在报告每获得一个 QALY 的成本结果的研究中，自我管理并没有导致与常规护理相比具有统计学意义的 QALY 收益（仅有一个例外）。有 8 项研究表明，自我管理干预措施的开发和实施成本可能会部分抵消后续减少卫生保健资源使用所带来的节省。
在患有慢性疼痛的老年人群（平均年龄超过 60 岁）中，自我管理是有效的，并且当使用西安大略和麦克马斯特大学骨关节炎指数疼痛评分来衡量结果时，可能具有成本效益。当使用 QALY 指标衡量时，成本效益的确定性较低。对于成本效益的结论存在不确定性，部分原因是缺乏关于社会对疼痛改善的支付意愿的信息。需要进行大型、多中心、高质量的 RCT 来专门在老年人群中（例如，已经达到法定退休年龄的人群）证实本综述的研究结果。
