Edwards Karlyn A, Smith Kenneth J, Jones Katie Fitzgerald, Bair Matthew J, Liebschutz Jane M, McGill Lakeya S, Agil Deana, Johnson Mallory O, Thomas Tammi, Clay Olivio J, Farel Claire E, Napravnik Sonia, Long Dustin, Burkholder Greer, Browne Lindsay, Durr Amy L, Johnson Bernadette, Demonte William, Orris Sarah Margaret, Merlin Jessica S
Division of General Internal Medicine Department of Medicine University of Pittsburgh.
New England Geriatric Research Education and Clinical Center Section of Palliative Care VA Boston Healthcare System Boston, MA.
J Acquir Immune Defic Syndr. 2025 Apr 3. doi: 10.1097/QAI.0000000000003671.
Pain self-management (PSM) interventions are low risk, effective interventions for chronic pain that have high potential for scalability. Economic evaluations are a key component to assessing scalability. We evaluated the cost-effectiveness of a tailored PSM called Skills to Manage Pain (STOMP) as compared to enhanced usual care (EUC) among people with HIV (PWH) and chronic pain.
and Methods: Data are from a randomized controlled trial of STOMP (N = 278). From a healthcare perspective, a Markov decision analysis model over a 12-month time horizon was used. Participants were recruited from two academic medical centers within the Center for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort. STOMP involves six individual sessions and six peer-led group sessions. The EUC control group received the STOMP treatment manual. The primary outcome was the incremental cost-effectiveness ratio, defined as US dollars per quality-adjusted life-year (QALY) gained derived from trial-based Medical Outcomes Study Short-Form 12 (SF-12) data. Sensitivity analyses examined the effects of parameters varied individually and collectively on model results.
Participants were middle-aged (M=53.5, SD=10), male (53%), and Black/African American (81%). Model calculation of effectiveness over the 12-month time horizon resulted in 0.570 QALYs for EUC and 0.603 QALYs for the STOMP intervention, or 0.033 QALYs gained by STOMP compared to EUC. In probabilistic sensitivity analyses that varied all parameters simultaneously, the STOMP intervention was favored in 98.0% of 10,000 model iterations at a $100,000/QALY threshold.
STOMP is a cost-effective and scalable PSM intervention for PWH and chronic pain.
疼痛自我管理（PSM）干预措施是针对慢性疼痛的低风险、有效干预措施，具有很高的可扩展性潜力。经济评估是评估可扩展性的关键组成部分。我们评估了一种名为疼痛管理技能（STOMP）的定制PSM与强化常规护理（EUC）相比，在艾滋病毒感染者（PWH）和慢性疼痛患者中的成本效益。
数据来自一项STOMP的随机对照试验（N = 278）。从医疗保健角度出发，使用了一个为期12个月的马尔可夫决策分析模型。参与者从综合临床系统艾滋病研究网络（CNICS）队列中的两个学术医疗中心招募。STOMP包括六次个体课程和六次同伴主导的小组课程。EUC对照组收到了STOMP治疗手册。主要结果是增量成本效益比，定义为每获得一个质量调整生命年（QALY）的美元数，该数据来自基于试验的医学结果研究简表12（SF - 12）数据。敏感性分析检查了参数单独和集体变化对模型结果的影响。
参与者为中年（M = 53.5，标准差 = 10），男性（53%），黑人/非裔美国人（81%）。在12个月时间范围内的有效性模型计算得出，EUC为0.570个QALY，STOMP干预为0.603个QALY，与EUC相比，STOMP获得了0.033个QALY。在同时改变所有参数的概率敏感性分析中，在每QALY阈值为100,000美元时，STOMP干预在10,000次模型迭代中的98.0%中更受青睐。
STOMP是一种对PWH和慢性疼痛具有成本效益且可扩展的PSM干预措施。
