Academic Unit of Health Economics,Leeds Institute of Health Sciences, University of Leeds,United Kingdom.
Academic Unit of Palliative Care,Leeds Institute of Health Sciences, University of Leeds,United Kingdom.
Int J Technol Assess Health Care. 2019 Jan;35(2):141-149. doi: 10.1017/S0266462319000114. Epub 2019 Mar 15.
Uncontrolled pain in advanced cancer is a common problem and has significant impact on individuals' quality of life and use of healthcare resources. Interventions to help manage pain at the end of life are available, but there is limited economic evidence to support their wider implementation. We conducted a case study economic evaluation of two pain self-management interventions (PainCheck and Tackling Cancer Pain Toolkit [TCPT]) compared with usual care.
We generated a decision-analytic model to facilitate the evaluation. This modelled the survival of individuals at the end of life as they moved through pain severity categories. Intervention effectiveness was based on published meta-analyses results. The evaluation was conducted from the perspective of the U.K. health service provider and reported cost per quality-adjusted life-year (QALY).
PainCheck and TCPT were cheaper (respective incremental costs -GBP148 [-EUR168.53] and -GBP474 [-EUR539.74]) and more effective (respective incremental QALYs of 0.010 and 0.013) than usual care. There was a 65 percent and 99.5 percent chance of cost-effectiveness for PainCheck and TCPT, respectively. Results were relatively robust to sensitivity analyses. The most important driver of cost-effectiveness was level of pain reduction (intervention effectiveness). Although cost savings were modest per patient, these were considerable when accounting for the number of potential intervention beneficiaries.
Educational and monitoring/feedback interventions have the potential to be cost-effective. Economic evaluations based on estimates of effectiveness from published meta-analyses and using a decision modeling approach can support commissioning decisions and implementation of pain management strategies.
晚期癌症患者的疼痛无法得到控制是一个常见问题，会对患者的生活质量和医疗资源的使用产生重大影响。虽然有一些干预措施可以帮助控制临终前的疼痛，但支持其更广泛应用的经济证据有限。我们对两种疼痛自我管理干预措施（PainCheck 和 Tackling Cancer Pain Toolkit [TCPT]）与常规护理进行了病例研究经济评估。
我们生成了一个决策分析模型来进行评估。该模型根据个体在疼痛严重程度类别中的生存情况进行建模。干预效果基于已发表的荟萃分析结果。该评估从英国卫生服务提供者的角度出发，报告了每质量调整生命年（QALY）的成本。
PainCheck 和 TCPT 的成本更低（增量成本分别为-GBP148 [-EUR168.53]和-GBP474 [-EUR539.74]），效果更好（增量 QALY 分别为 0.010 和 0.013），优于常规护理。PainCheck 和 TCPT 的成本效益分别有 65%和 99.5%的可能性。敏感性分析结果相对稳健。成本效益的最重要驱动因素是疼痛缓解程度（干预效果）。虽然每个患者的成本节约幅度较小，但考虑到潜在干预受益人数，这些节约幅度相当可观。
教育和监测/反馈干预措施具有成本效益的潜力。基于已发表荟萃分析的有效性估计和使用决策建模方法进行的经济评估可以支持疼痛管理策略的委托决策和实施。
