Gong Cynthia L, Okoro Chelsea C, Wan Ruihan, Lopez Cristal, Ngo Nhat H, Gold Jeffrey I
Department of Pediatrics, Division of Neonatology, Fetal and Neonatal Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California.
The Biobehavioral Pain Lab, Department of Anesthesiology Critical Care Medicine.
Clin J Pain. 2025 Mar 1;41(3):e1271. doi: 10.1097/AJP.0000000000001271.
Chronic pain is a leading cause of morbidity in children and adolescents globally but can be managed with a combination of traditional Western medicine and integrative medicine (IM) practices. This combination has improved various critical health outcomes, such as quality of life, sleep, pain, anxiety, and health care utilization. These IM practices include acupuncture, yoga, biofeedback, massage, mindfulness, or any combination of these modalities. The current article developed a budget impact model to estimate the institutional costs of implementing these practices among adolescents.
A decision tree was used to estimate the reduction in hospitalizations and emergency department (ED) use based on a previously published retrospective analysis of children receiving IM practices comparing utilization rates 1-year pre-implementation and post-implementation of IM services (Figure 1). Costs associated with implementing each modality were based on hourly compensation rates for licensed professionals administering each service and equipment associated with delivery (eg, acupuncture needles, biofeedback equipment, and sensors). The cost of each hospitalization and ED visit was derived from the literature. In addition, cost savings were estimated based on government-contracted and commercial-contracted reimbursement rates for each service.
Cost savings were approximated to range from $1344 to $3439 per patient, with even greater cost savings of up to $6000 and $4132 when accounting for governmental and commercial payer reimbursement, respectively.
IM leads to improved pain relief when combined with traditional medicine and yields significant cost savings, thus supporting the routine implementation of IM alongside traditional medicine in health care settings.
慢性疼痛是全球儿童和青少年发病的主要原因,但可通过结合传统西医和整合医学(IM)实践来进行管理。这种结合改善了各种关键的健康指标,如生活质量、睡眠、疼痛、焦虑以及医疗保健利用率。这些IM实践包括针灸、瑜伽、生物反馈、按摩、正念或这些方式的任何组合。本文建立了一个预算影响模型,以估计在青少年中实施这些实践的机构成本。
基于之前发表的对接受IM实践的儿童的回顾性分析,使用决策树来估计住院和急诊就诊次数的减少情况,该分析比较了IM服务实施前1年和实施后1年的利用率(图1)。实施每种方式的成本基于提供每项服务的持牌专业人员的小时薪酬率以及与服务提供相关的设备(如针灸针、生物反馈设备和传感器)。每次住院和急诊就诊的成本来自文献。此外,还根据每项服务的政府合同和商业合同报销率估计了成本节约情况。
每位患者的成本节约估计在1344美元至3439美元之间,若分别考虑政府和商业付款人的报销情况,成本节约甚至更高,分别可达6000美元和4132美元。
IM与传统医学结合可改善疼痛缓解情况,并产生显著的成本节约,因此支持在医疗保健环境中将IM与传统医学一起常规实施。