Takura Tomoyuki, Shibata Masahiko, Inoue Shinsuke, Matsuda Yoichi, Uematsu Hironobu, Yamada Keiko, Ushida Takahiro
Department of Health Care Economics and Industrial Policy, Graduate School of Medicine, Osaka University, Osaka, Japan.
Department of Pain Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka Suita, Osaka, 565-0871, Japan.
J Anesth. 2016 Aug;30(4):553-61. doi: 10.1007/s00540-016-2162-9. Epub 2016 Mar 22.
The purpose of this study was to examine the cost-effectiveness of pain treatments in two pain centers in Japan.
The study population comprised 91 patients receiving various treatments for chronic pain, which were divided into three categories: (1) medication, (2) medication + nerve block, and (3) other modalities (exercise and/or pain education). Pain was assessed using the Pain Disability Assessment Scale (PDAS) score, Hospital Anxiety and Depression Scale (HADS) score, Pain Catastrophizing Scale (PCS) score, and EQ-5D score. First, the reliability of the EQ-5D score first assessed by evaluating the correlation this score with those of the other pain-related evaluation instruments, and then the cost effectiveness of the pain treatments was evaluated. Evaluation of medical costs was based on data provided from the Management Services of the hospital, which in turn were based on national health scheme medical treatment fees. The quality-adjusted life year (QALY) value was calculated from the EQ-5D score, converted to 12 months, and then used for cost-benefit analysis along with medical treatment fees.
According to the recent IASP classification, more patients had chronic neuropathic pain (41) than chronic primary pain (37 patients) or chronic musculoskeletal pain (27 patients). There was a significant correlation between the EQ-5D score and the PDAS, HADS, and PCS scores, which demonstrated the reliability of the EQ-5D score. Significant improvement in the HADS, PCS, and EQ-5D scores was noted after 3 months of pain treatment. Calculation of the cost-effectiveness based on the estimated annual medical treatment cost and QALY revealed a mean value of US $45,879 ± 103,155 per QALY (median US $16,903), indicating adequate socioeconomic utility.
Based on our results, the EQ-5D is reliable for evaluating chronic pain in patients. The medico-economic balance was appropriate for all treatments provided in two comprehensive pain centers in Japan.
本研究旨在探讨日本两个疼痛中心疼痛治疗的成本效益。
研究对象包括91例接受各种慢性疼痛治疗的患者，这些治疗分为三类：（1）药物治疗；（2）药物治疗+神经阻滞；（3）其他方式（运动和/或疼痛教育）。使用疼痛残疾评估量表（PDAS）评分、医院焦虑抑郁量表（HADS）评分、疼痛灾难化量表（PCS）评分和EQ-5D评分评估疼痛。首先，通过评估EQ-5D评分与其他疼痛相关评估工具评分之间的相关性，首次评估EQ-5D评分的可靠性，然后评估疼痛治疗的成本效益。医疗成本评估基于医院管理服务提供的数据，而这些数据又基于国家健康计划医疗费用。质量调整生命年（QALY）值根据EQ-5D评分计算得出，转换为12个月，然后与医疗费用一起用于成本效益分析。
根据最近的国际疼痛研究协会（IASP）分类，患有慢性神经病理性疼痛的患者（41例）多于慢性原发性疼痛患者（37例）或慢性肌肉骨骼疼痛患者（27例）。EQ-5D评分与PDAS、HADS和PCS评分之间存在显著相关性，这证明了EQ-5D评分的可靠性。疼痛治疗3个月后，HADS、PCS和EQ-5D评分有显著改善。根据估计的年度医疗成本和QALY计算成本效益，结果显示每QALY的平均值为45,879美元±103,155美元（中位数为16,903美元），表明具有足够的社会经济效用。
基于我们的研究结果，EQ-5D在评估患者慢性疼痛方面是可靠的。在日本的两个综合疼痛中心提供的所有治疗中，医疗经济平衡是合适的。
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