Pain Management Research Institute, Sydney Medical School.
Department of Mathematics and Statistics, Macquarie University.
Clin J Pain. 2021 Nov 22;38(3):197-207. doi: 10.1097/AJP.0000000000001009.
Chronic musculoskeletal pain in adults is a global health and economic problem. The aim of this paper was to systematically review and determine what proportion of multidisciplinary approaches to managing chronic musculoskeletal pain are cost-effective.
The EconLit, Embase, and PubMed electronic databases were searched for randomized and nonrandomized economic evaluation studies of nonpharmaceutical multidisciplinary chronic pain management interventions published from inception through to August 2019.
Seven studies comprising 2095 patients were included. All studies involved diverse multidisciplinary teams in one or more of the study arms. All studies involved chronic (both chronic and subacute) low back pain and were economic evaluations from either a societal or health care perspective. Two of the 3 studies that reported on a multidisciplinary pain intervention compared with nonmultidisciplinary intervention concluded favorable cost-effectiveness based on cost per quality adjusted life years gained, 1 study was not found to be cost-effective. Cost-effectiveness of the multidisciplinary intervention of interest was also not established by another 3-arm study. Two studies compared 2 multidisciplinary interventions; neither of these could definitively declare cost-effectiveness. The remaining study indicated the intervention by a multidisciplinary team was more effective but at a higher cost. None of the included studies used decision models to estimate long-term health outcomes and cost-effectiveness of multidisciplinary programs.
There are few studies on the cost-effectiveness of multidisciplinary chronic pain management interventions. This study encourages additional rigorous economic evaluations of multidisciplinary models for chronic pain management. Economic evaluations that enable extrapolating costs and effects of multidisciplinary programs beyond the time horizon of clinical trials may be more informative for clinicians and health administrators.
成人慢性肌肉骨骼疼痛是一个全球性的健康和经济问题。本文旨在系统回顾和确定管理慢性肌肉骨骼疼痛的多学科方法中有多少具有成本效益。
检索 EconLit、Embase 和 PubMed 电子数据库，以查找 2019 年 8 月以前发表的非药物多学科慢性疼痛管理干预的随机和非随机经济评估研究。
纳入的 7 项研究共包括 2095 例患者。所有研究均涉及单一或多种研究臂的多元化多学科团队。所有研究均涉及慢性（慢性和亚急性）腰痛，从社会或医疗保健角度进行经济评估。3 项报告多学科疼痛干预与非多学科干预比较的研究中有 2 项基于每获得一个质量调整生命年的成本得出了有利的成本效益结论，1 项研究被认为没有成本效益。另一个 3 臂研究也没有确定多学科干预的成本效益。两项研究比较了 2 种多学科干预措施；这两项研究都无法明确宣布成本效益。其余的研究表明，多学科团队的干预措施更有效，但成本更高。没有纳入的研究使用决策模型来估计多学科计划的长期健康结果和成本效益。
关于多学科慢性疼痛管理干预的成本效益的研究很少。本研究鼓励对多学科慢性疼痛管理模式进行更多严格的经济评估。能够将多学科方案的成本和效果推断到临床试验时间范围之外的经济评估可能对临床医生和卫生管理人员更有帮助。
