Merlin Jessica S, Westfall Andrew O, Johnson Mallory O, Kerns Robert D, Bair Matthew J, Kertesz Stefan, Turan Janet M, Clay Olivio J, Starrels Joanna L, Kilgore Meredith
a Division of Infectious Diseases , University of Alabama at Birmingham , Birmingham , AL , USA.
b Division of Gerontology, Geriatrics, and Palliative Care , University of Alabama at Birmingham , Birmingham , AL , USA.
J Med Econ. 2018 Feb;21(2):122-126. doi: 10.1080/13696998.2017.1377719. Epub 2017 Sep 18.
Chronic pain is a common, disabling, and costly comorbidity, particularly in people living with HIV (PLWH). This study developed and pilot tested a pain self-management intervention for chronic pain tailored to PLWH called Skills TO Manage Pain (STOMP).
Given the additional resources needed to deliver STOMP in HIV clinical settings, an important objective of the pilot study was to assess not only STOMP's preliminary efficacy, but also its cost-effectiveness.
The present study draws from a 44-participant, 2-arm randomized pilot trial of the STOMP intervention vs usual care among PLWH and at least moderate chronic pain (Clinicaltrials.gov: NCT02824562). Cost-effectiveness is presented as the incremental cost-effectiveness ratio (ICER). Costs were considered from the clinic perspective over a 1-year time horizon using real costs from the pilot trial. It was conservatively assumed there would be no costs savings. The Standard Gamble (SG) method was used to directly measure utilities.
Thirty-six participants met inclusion criteria for the present analyses. Mean age was 52 years; 61% were female and 86% were black. The total cost of STOMP was $483.83 per person. Using the SG method, the change in QALYs was 0.15, corresponding to an ICER of $3,225.
STOMP's cost/QALY is substantially lower than the $50,000 to $100,000/QALY benchmark often used to indicate cost-effectiveness. Although based on a pilot trial and, therefore, preliminary, these findings are promising, and suggest the importance of cost analyses in future STOMP trials.
慢性疼痛是一种常见、致残且代价高昂的合并症，在艾滋病毒感染者（PLWH）中尤为如此。本研究开发并进行了一项针对PLWH的慢性疼痛自我管理干预措施，称为疼痛管理技能（STOMP）的试点测试。
鉴于在艾滋病毒临床环境中实施STOMP需要额外资源，该试点研究的一个重要目标不仅是评估STOMP的初步疗效，还要评估其成本效益。
本研究来自一项有44名参与者的双臂随机试点试验，该试验对比了STOMP干预措施与PLWH中至少患有中度慢性疼痛的常规护理（Clinicaltrials.gov：NCT02824562）。成本效益以增量成本效益比（ICER）表示。从诊所角度，使用试点试验的实际成本，在1年时间范围内考虑成本。保守地假设不会有成本节省。采用标准博弈（SG）方法直接测量效用。
36名参与者符合本分析的纳入标准。平均年龄为52岁；61%为女性，86%为黑人。STOMP的人均总成本为483.83美元。使用SG方法，质量调整生命年（QALY）的变化为0.15，对应的ICER为3225美元。
STOMP的成本/ QALY显著低于通常用于表明成本效益的50,000至100,000美元/ QALY基准。尽管基于试点试验，因此是初步的，但这些发现很有前景，并表明在未来的STOMP试验中进行成本分析的重要性。
