eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia.
eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia.
J Pain. 2021 Mar;22(3):344-358. doi: 10.1016/j.jpain.2020.11.003. Epub 2020 Nov 20.
There is growing interest in the potential of internet-delivered pain management programs (PMPs) to increase access to care for people with chronic pain. However, very few economic evaluations of these interventions have been reported. Using existing data, the current study examined the cost-effectiveness of an internet-delivered PMP for a mixed group chronic pain patients (n = 490) provided with different levels of clinician support. The findings indicated that each additional clinical outcome (defined as a ≥ 30% reduction in disability, depression, anxiety, and pain) was associated with cost-savings when the intervention was provided in a self-guided format (ICER range: -$404--$808 AUD) or an optional-guided format (ICER range: -$314--$541 AUD), and a relatively small fixed cost when provided in the clinician-guided format (ICER range: $88-$225 AUD). The results were driven by a reduction in service use costs among the treatment groups, which offset the costs of providing the internet-delivered PMP in the self-guided and optional-guided formats. The same general pattern of results was found when more stringent clinical outcomes (defined as a ≥ 50% reduction) were employed. These findings suggest that carefully developed and administered internet-delivered PMPs, provided with different levels of clinician support, can be highly cost effective for patients with a broad range of pain conditions. PERSPECTIVE: This study examines the cost-effectiveness of an internet-delivered PMP provided to adults with a broad range of chronic pain conditions. Evidence of cost-effectiveness was found across a broad range of clinical outcomes and with different levels of clinician support.
人们对互联网提供的疼痛管理方案（PMP）增加慢性疼痛患者获得治疗的潜力越来越感兴趣。然而，很少有对这些干预措施进行经济评估的报道。本研究利用现有数据，考察了一种为混合组慢性疼痛患者（n=490）提供不同水平临床医生支持的互联网 PMP 的成本效益。研究结果表明，当干预措施以自我指导的形式（增量成本效益比范围：-404 至-808 澳元）或可选指导的形式（增量成本效益比范围：-314 至-541 澳元）提供时，每增加一个临床结果（定义为残疾、抑郁、焦虑和疼痛的改善幅度均超过 30%）与成本节约相关，而当以临床医生指导的形式提供时，其增量成本效益比范围则为 88 至 225 澳元）。治疗组服务使用成本的降低导致了结果的变化，从而抵消了自我指导和可选指导模式下提供互联网 PMP 的成本。当采用更严格的临床结果（定义为改善幅度超过 50%）时，也得到了大致相同的结果。这些发现表明，精心开发和管理的互联网 PMP，提供不同水平的临床医生支持，可以为具有广泛疼痛状况的患者提供高度的成本效益。观点：本研究考察了为广泛慢性疼痛患者提供的互联网 PMP 的成本效益。在广泛的临床结果范围内和不同水平的临床医生支持下，都发现了成本效益的证据。
