Hambraeus Johan, Norström Fredrik, Lindholm Lars
Department of Epidemiology and Global Health, Umeå University, 90185, Umeå, Sweden.
Smartkliniken Eques Indolor AB, Stolp-Ekeby 24 Tallbacken, 18695, Vallentuna, Sweden.
Interv Pain Med. 2022 Oct 7;1(4):100147. doi: 10.1016/j.inpm.2022.100147. eCollection 2022 Dec.
Chronic pain is a widespread condition that causes much suffering and significant cost to society. Pain rehabilitation programs (REH) have dominated the treatment of chronic pain in Sweden in recent decades. Although radiofrequency neurotomy (RFN) was cost-effective in recent studies, the long-term health and economic effects of REH have not been comprehensively evaluated.
Observational study with propensity score weighting to compare RFN and REH.
Patients assessed and treated between 2010 and 2016 were eligible; 15,357 underwent REH and 254 underwent RFN. Patient data were combined with linked data from national registers. We used propensity score weighting to mimic a randomized controlled trial using baseline gender, age, and baseline health-related quality of life as covariates.
Health-related quality of life improved significantly in both groups, by 0.164 and 0.352 quality-adjusted life years (QALYs) at 1 and 2 years after REH, and by 0.186 and 0.448 QALYs after RFN. The assessment and diagnostic procedures were slightly more expensive for RFN, but the treatment costs were greater for REH. Sick leave decreased after treatment in both groups, particularly after RFN. The cost per QALY gained 1 year after REH was ∼121,633 USD, which is considered "very expensive" according to the Swedish National Board of Health and Welfare. By comparison, the cost of RFN was ∼13,715 USD, in the "moderate" range. After 2 years the cost per QALY gained was in the "moderate" range for REH and "low" for RFN.
RFN and REH improved health-related quality of life, with significantly greater improvement with RFN. The treatments were comparable based on propensity score weighting, and RFN was cost-effective in the moderate to low range, whereas REH was considered very expensive to moderate. Expanding RFN from 2% currently to 25% of the treatments given in Sweden could save ∼21.2 million USD annually in healthcare expenditure.
慢性疼痛是一种普遍存在的病症，给患者带来巨大痛苦，并给社会造成高昂成本。近几十年来，疼痛康复项目（REH）在瑞典一直主导着慢性疼痛的治疗。尽管在近期研究中射频神经切断术（RFN）具有成本效益，但REH的长期健康和经济影响尚未得到全面评估。
采用倾向评分加权的观察性研究，以比较RFN和REH。
2010年至2016年间接受评估和治疗的患者符合条件；15357例接受了REH，254例接受了RFN。患者数据与来自国家登记处的关联数据相结合。我们使用倾向评分加权，以基线性别、年龄和基线健康相关生活质量作为协变量，模拟一项随机对照试验。
两组的健康相关生活质量均有显著改善，REH后1年和2年分别提高了0.164和0.352质量调整生命年（QALY），RFN后分别提高了0.186和0.448 QALY。RFN的评估和诊断程序成本略高，但REH的治疗成本更高。两组治疗后病假均减少，尤其是RFN后。REH后1年每获得一个QALY的成本约为121,633美元，根据瑞典国家卫生和福利委员会的标准，这被认为“非常昂贵”。相比之下，RFN的成本约为13,715美元，处于“中等”范围。2年后，REH每获得一个QALY的成本处于“中等”范围，RFN则处于“低”范围。
RFN和REH均改善了健康相关生活质量，RFN的改善更为显著。基于倾向评分加权，两种治疗方法具有可比性，RFN在中低范围内具有成本效益，而REH则被认为非常昂贵至中等昂贵。将RFN在瑞典目前的治疗比例从2%提高到25%，每年可节省约2120万美元的医疗保健支出。
