Hassenbusch S J, Paice J A, Patt R B, Bedder M D, Bell G K
Department of Neurosurgery, University of Texas, MD Anderson Cancer Center, Houston 77030, USA.
J Pain Symptom Manage. 1997 Sep;14(3 Suppl):S36-48. doi: 10.1016/s0885-3924(97)00169-3.
The estimated annual cost of medical management of chronic back pain is $25 billion. Such management is often ineffective and overly costly. Most physicians who have employed intrathecal pain therapy attest to its efficacy in the management of intractable chronic pain. However, few economic analyses are available to evaluate the cost effectiveness of different modalities and to aid in clinical decision making and third-party reimbursement policies. Current analyses tend to focus on short-term cost-benefit measurements and to ignore variables such as quality of life and patient functioning. This bias has impaired the ability of payers to make appropriate decisions regarding the safety, cost effectiveness, and efficacy of intrathecal pain therapy in noncancer patients. Clinical data demonstrate that for cancer patients whose expectancies exceed 3 months, the overall costs of intrathecal pain therapy may be less than those of tunneled epidural catheters or external infusion devices. In nonmalignant pain, intrathecal therapy appears to be cost effective compared to conventional medical management at 22 months. Further debate and fine tuning of these economic models from all perspectives are required.
慢性背痛的年度医疗管理费用估计为250亿美元。这种管理往往效果不佳且成本过高。大多数采用鞘内镇痛疗法的医生都证实其在治疗顽固性慢性疼痛方面的有效性。然而，很少有经济分析可用于评估不同治疗方式的成本效益，也无法帮助进行临床决策和制定第三方报销政策。目前的分析往往侧重于短期成本效益衡量，而忽略了生活质量和患者功能等变量。这种偏差削弱了支付方就鞘内镇痛疗法在非癌症患者中的安全性、成本效益和疗效做出适当决策的能力。临床数据表明，对于预期寿命超过3个月的癌症患者，鞘内镇痛疗法的总体成本可能低于隧道式硬膜外导管或外部输注装置的成本。在非恶性疼痛中，与传统医疗管理相比，鞘内治疗在22个月时似乎具有成本效益。需要从各个角度对这些经济模型进行进一步的辩论和微调。
