Wagner C J, Ayyad G, Otzdorff A, Bienek K, Marnitz U, Pickardt B von, Seidel W, Sehlen S, Supantia P, Lindena G
AOK Nordost, Wilhelmstraße 1, 10963, Berlin, Deutschland.
Reha-Tagesklinik im Forum Pankow GmbH und Co. KG, Hadlichstraße 19, 13187, Berlin, Deutschland.
Schmerz. 2019 Apr;33(2):128-138. doi: 10.1007/s00482-019-0356-4.
Persons insured by AOK Nordost statutory health insurance (SHI) and on sick leave underwent a 20-day program of interdisciplinary multimodal pain therapy (IMST) following an initial assessment (IA). We evaluated its effectiveness regarding sick leave, utilization/costs of SHI services, and patient-reported characteristics of pain.
Participants with >14 days of IMST in 2013-2015 and with data necessary for comparison (intervention group, IG) were matched 1:1 in 2 steps. From AOK Nordost data, we identified a comparison group (CG) having characteristics matching exactly and by propensity score. Starting on the IA (IG) or a comparable reference day (CG), we analyzed utilization/costs of services related to back pain for 365 days. Participants' characteristics of pain were surveyed on the IA day and within 183-365 days.
The 86 IG patients had on average 44.33 (median 12) days of sick leave less than the CG after their initial sick leave starting at the IA (significant, p <0.05). Fewer IG patients had ≥1 hospitalization (OR 0.33; 95%CI 0.12-0.88), ≥1 prescription of physiotherapy (OR 0.35; 95%CI 0.24-0.82), and ≥1 specialist visit (OR 0.39; 95%CI 0.10-0.52) related to back pain. More IG patients had "lasting absence of treatment" (OR 4.06; 95%CI 1.09-15.1). Follow-up interviews were available for 56 IG patients, showing less pain intensity, impairment by pain, and pain severity (significant). Regarding the SHI perspective, cost savings per patient nearly covered the IA and IMST costs.
For a selected comparable population treated by protocol, IA and IMST was associated with reduction or "lasting absence" of treatment, pain relief, and major savings on sickness benefits. Other than in previous studies we found coverage of IA and IMST costs without consideration of productivity loss.
德国东北法定健康保险（SHI）的参保人员在病假期间，在进行初步评估（IA）后接受了为期20天的跨学科多模式疼痛治疗（IMST）项目。我们评估了该项目在病假、SHI服务利用/成本以及患者报告的疼痛特征方面的有效性。
2013 - 2015年接受超过14天IMST且具备比较所需数据的参与者（干预组，IG）分两步进行1:1匹配。从德国东北法定健康保险的数据中，我们确定了一个特征完全匹配且通过倾向得分匹配的对照组（CG）。从IA（IG）或可比参考日（CG）开始，我们分析了365天内与背痛相关的服务利用/成本。在IA日以及183 - 365天内对参与者的疼痛特征进行了调查。
86名IG患者在从IA开始首次病假后，平均病假天数比CG少44.33天（中位数12天）（具有统计学意义，p <0.05）。与背痛相关的，IG患者中住院≥1次（比值比0.33；95%置信区间0.12 - 0.88）、理疗处方≥1次（比值比0.35；95%置信区间0.24 - 0.82）以及专科就诊≥1次（比值比0.39；95%置信区间0.10 - 0.52）的情况较少。更多IG患者出现“长期无需治疗”（比值比4.06；95%置信区间1.09 - 15.1）。对56名IG患者进行了随访访谈，结果显示疼痛强度、疼痛造成的损害以及疼痛严重程度均有所减轻（具有统计学意义）。从SHI的角度来看，每位患者节省的费用几乎覆盖了IA和IMST的成本。
对于按方案治疗的选定可比人群，IA和IMST与治疗的减少或“长期无需治疗”、疼痛缓解以及疾病津贴的大幅节省相关。与之前的研究不同，我们发现IA和IMST的成本得到了覆盖，且未考虑生产力损失。
