Ruhe Ann-Kristin, Frosch Michael, Wager Julia, Linder Roland, Pfenning Ingo, Sauerland Dirk, Zernikow Boris
*German Paediatric Pain Centre, Children's and Adolescents' Hospital, and Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health-School of Medicine ‡Institutional Economics and Health Policy, Witten/Herdecke University, Germany †Scientific Institute of the TK (Techniker Krankenkasse) for Benefit and Efficiency in Health Care, Hamburg, Germany.
Clin J Pain. 2017 Sep;33(9):767-776. doi: 10.1097/AJP.0000000000000460.
The aim of this study was to analyze changes in health care utilization and cost among a sample of highly impaired children and adolescents who sought a 3-week intensive interdisciplinary pain treatment (IIPT).
Claims data from 7 statutory health insurance companies were analyzed for 65 children and adolescents who sought IIPT at the German Paediatric Pain Centre. The annual health care utilization and cost were determined for the following 4 areas: outpatient care, inpatient care, medications, and remedies and aids. We analyzed the changes in resource utilization in the year before (pre_1 y) IIPT and in the subsequent year (post_1 y).
Within the first year after IIPT, overall health care costs did not decrease significantly. However, the pattern of health care utilization changed. First, significantly more children and adolescents started outpatient psychotherapy (P=0.001). Second, the number of hospitalized children decreased significantly from 1-year pre to 1-year post (P=0.001). Accordingly, there were significantly fewer hospitalizations for primary chronic pain disorders at 1-year post (P<0.001). The prescription of nonopioids, co-analgesics and opioids was significantly reduced from 1-year pre to 1-year post (all P<0.013).
The present results indicate that the health care costs of children and adolescents with severe chronic pain disorders do not significantly decrease 1 year after IIPT; however, the treatment becomes more goal-focused. Differential diagnosis measures and nonindicated therapeutic interventions decreased, and more indicated interventions, such as psychotherapy, were used. Future research is needed to investigate the economic long-term changes after IIPT.
本研究旨在分析寻求为期3周强化跨学科疼痛治疗（IIPT）的严重受损儿童和青少年样本的医疗保健利用和成本变化。
分析了7家法定健康保险公司的理赔数据，这些数据来自65名在德国儿科疼痛中心寻求IIPT治疗的儿童和青少年。确定了以下4个领域的年度医疗保健利用情况和成本：门诊护理、住院护理、药物以及治疗手段和辅助器具。我们分析了IIPT前一年（pre_1 y）和随后一年（post_1 y）资源利用的变化情况。
在IIPT后的第一年，总体医疗保健成本没有显著下降。然而，医疗保健利用模式发生了变化。首先，显著更多的儿童和青少年开始接受门诊心理治疗（P = 0.001）。其次，住院儿童的数量从治疗前1年到治疗后1年显著减少（P = 0.001）。相应地，治疗后1年原发性慢性疼痛疾病的住院次数显著减少（P < 0.001）。从治疗前1年到治疗后1年，非阿片类药物、辅助镇痛药和阿片类药物的处方量显著减少（所有P < 0.013）。
目前的结果表明，患有严重慢性疼痛疾病的儿童和青少年在接受IIPT治疗1年后，医疗保健成本没有显著下降；然而，治疗变得更具目标针对性。鉴别诊断措施和非必要的治疗干预减少，而更多必要的干预措施，如心理治疗，得到了应用。需要进一步的研究来调查IIPT后经济方面的长期变化。
