عنوان البحث:
|
Describing the characteristics, treatment
pathways, outcomes, and costs of people with persistent noncancer pain
managed by community pain clinics and generating an indicative estimate of
cost-effectiveness: feasibility study protocol
|
موجز عن البحث:
|
Background: Low back pain (LBP) and fibromyalgia (FM), also
known as chronic widespread pain (CWP), are highly prevalent chronic painful
conditions that have substantial impact on patients, health care systems, and
society. Diagnosis is complex and management strategies are associated with
various levels of evidence for effectiveness and cost-effectiveness.
Multidisciplinary pain services have been shown to be effective in some
settings and therefore are recommended by clinical practice guidelines as a
rational treatment option to manage these patients. Knowing that these
services are resource intensive, evidence is needed to demonstrate their
cost-effectiveness. This study aims to describe the management of patients
with LBP and FM in two community pain clinics to derive an indicative
estimate of cost-effectiveness compared with standard practice.
Methods: This is a prospective observational multicenter study, using
patient-level data. The data from this study will be combined with modelling
of the long-term economic impact of community pain clinics in treating people
with LBP and FM. Newly referred patients with LBP and FM who provide written
consent will be included. We will collect data on functional disability, pain
intensity, quality of life, and health resource utilization. Follow-up data
at the 3- and 6-month points will be collected by patient-completed
questionnaires and health care contact diaries. Health care resource use from
diaries will be compared with patient electronic records to assess the
agreement between these recording methods. Patient cohort characteristics,
treatment pathways, resource use, and outcomes derived from this study will
be integrated in a decision analysis model to assess the cost-effectiveness
of community pain clinics compared with standard care. This feasibility study
will address key methodological issues such as sample estimates and retention
rate to inform the design of a future randomized controlled trial.
|
موجز عن البحث:
|
Objectives
The objective of this literature review
was to explore the existing evidences regarding the economic evaluation of
multidisciplinary pain management services in managing people with
fibromyalgia or chronic widespread pain.
Methods
Electronic search of Embase, MEDLINE,
PsychoINFO, NHS EED, JBI, and Cochrane database was performed. Studies
published from the time of the respective database inception to April 2015
were considered for inclusion in this review. The quality of studies was
assessed using the Cochrane Back Review Group and the Consolidated Health
Economic Evaluation Reporting Standards (CHEERS).
Results
The literature review allowed
retrieving 620 studies of which 6 fulfilled the eligibility criteria. All
included studies were economic evaluations alongside randomized clinical
trials published between 1996 and 2015. Two were from the UK, two from Spain,
and two from the Netherland. Risk of bias was high in two studies. The
intervention, comparators, disciplines involved, and number of sessions were
well described in most of the studies. variation between the included studies
were in type of interventions, length of administration, follow-up period,
and outcome measured. None of the studies met all CHEERS quality criteria. In
Five studies, multidisciplinary pain management services were cost-effective
at short-term follow up; however, this was not always maintained in long term
follow-up.
Conclusions
Due to the high level of heterogeneity
among selected studies, we were unable to make a definitive conclusion about
the cost-effectiveness of pain management services in managing people with
fibromyalgia or chronic widespread pain. Multidisciplinary pain management
services trials must be based on high methodological and economic quality to
determine the cost-effectiveness of multidisciplinary pain management
services.
|