A Cost-effectiveness Analysis of an Internet-delivered Pain Management Program Delivered With Different Levels of Clinician Support: Results From a Randomised Controlled Trial

Dear, Blake F.; Karin, Eyal; Fogliati, Rhiannon; Dudeney, Joanne; Nielssen, Olav; Scott, Allan; Gandy, Milena; Bisby, Madelyne A.; Heriseanu, Andreea I.; Hathway, Taylor; Staples, Lauren G.; Titov, Nickolai; Schroeder, Liz

doi:10.1016/j.jpain.2020.11.003

Cited by 20 publications

(20 citation statements)

References 41 publications

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“…The remaining health professionals all have standard consultation times and associated fees based on the MBS. Consistent with previous research, 11 the costs were calculated as follows: GPs ($37.05 AUD; 20-minute consultation), medical specialists ($97.61 AUD; 30-minute consultation), nurses ($10.26 AUD; 20-minute consultation), psychologists ($99.75 AUD; 50-minute consultation), physiotherapists or occupational therapists ($10.32 AUD; 20-minute consultation), counselors or social workers ($10.32 AUD; 20-minute consultation), and emergency ward-related consultations ($11.62 AUD; 20-minute consultation). The total costs for each health professional and medication was the product of the unit cost over the 8-week period.…”

Section: Cost Data Assessmentssupporting

confidence: 93%

“…The findings of this study replicate and extend an earlier health economic evaluation of the Pain Course, 11 which examined the cost-effectiveness of the program when provided with differing levels of clinician support. That study found similar evidence of clinical efficacy and acceptability and, consistent with the current study, that the program was associated with a cost of approximately $24 per participant when provided with “as-needed” support.…”

Section: Discussionsupporting

confidence: 73%

“…This compared with average costs of $131 and $9, respectively, when the intervention was provided with regular clinician support or without any support. 11 The previous study also found that the costs of the program in the optional support format were offset by reductions in health care and medication use in the intervention period, although this study found no clear evidence of cost reductions. The inconsistency is difficult to explain with the available data.…”

Section: Discussionmentioning

confidence: 54%

“…For consistency and comparison purposes, the same costing approach was used in the current study as with a previously published health economic evaluation. 11 Specifically, the unit costs for medication were collated from the Australian National Pharmaceutical Benefits Schedule list at 2019 prices. 13 Where required, primary bottom-up costing was conducted under the guidance of a medical practitioner.…”

Section: Cost Data Assessmentsmentioning

confidence: 99%

See 3 more Smart Citations

The Pain Course: a randomised controlled trial and economic evaluation of an internet-delivered pain management program

Dear

Karin

Fogliati

et al. 2021

Pain

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There is interest in the potential of Internet-delivered programs to cost-effectively increase access to pain management for people with chronic pain. However, few large-scale clinical and economic evaluations have been undertaken. Using a randomised controlled trial design, the current study (n 5 659) examined the clinical efficacy, cost-effectiveness, and cost utility of an Internetdelivered pain management program for people with mixed chronic pain conditions when delivered with optional clinician support. The treatment group reported significant improvements in disability, depression, anxiety, average pain intensity, and qualityadjusted life years (QALYs), compared with control, and exhibited relatively high levels of treatment engagement and satisfaction.

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Section: Cost Data Assessmentssupporting

confidence: 93%

Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 54%

Section: Cost Data Assessmentsmentioning

confidence: 99%

See 2 more Smart Citations

The Pain Course: a randomised controlled trial and economic evaluation of an internet-delivered pain management program

Dear

Karin

Fogliati

et al. 2021

Pain

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“…This represents a significant increase in demand, and is promising, as previous research suggests that Internet‐delivered cognitive behavioural PMPs contribute to considerable healthcare cost‐savings for each additional clinical outcome (i.e. depression, anxiety, disability and pain) that is reduced by 30% or greater (Dear et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Five‐year observational study of Internet‐delivered cognitive behavioural pain management when offered as routine care by an online therapy clinic

Hadjistavropoulos¹,

Peynenburg

Thiessen

et al. 2021

European Journal of Pain

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Background: Internet-delivered cognitive behavioural pain management programmes (PMPs) are effective, but less is known about their use outside of research trials. Five years of data from offering the Internet-delivered cognitive behavioural PMP in an online therapy clinic was examined to assess effectiveness, acceptability and predictors of outcomes.Methods: Patients (N = 293) were offered a previously validated 8-week Internet-delivered cognitive behavioural PMP and administered measures at pre-treatment, post-treatment and 3 months.Results: There was growth in demand for an Internet-delivered cognitive behavioural PMP over time (n = 64 first year to n = 133 fifth year). Moderate-tolarge improvements on depression (post-treatment 35% reduction; 3-month 41% reduction) and anxiety (post-treatment 37% reduction; 3-month 41% reduction), and small-to-moderate improvements on disability (post-treatment 19% reduction; 3-month 20% reduction) were found. Lesson completion and satisfaction were high. Lower pain acceptance, lower pain self-efficacy and higher pain intensity were associated with lower improvements on depression, anxiety and disability. Conclusions: This longitudinal observational study provides support forInternet-delivered cognitive behavioural PMPs when offered as routine care by an online therapy clinic. Significance:This 5-year observational study provides support for Internetdelivered cognitive behavioural pain management programs (PMPs) offered as routine care in an online therapy clinic. Interest in the service grew over 5 years.Outcomes, engagement and satisfaction were strong. Higher pain acceptance, pain self-efficacy and lower pain severity were associated with greater posttreatment improvements on depression, anxiety and disability.

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Sudden gains in depression and anxiety during an online pain management programme for chronic pain

Bisby,

Correa,

Trujillo

et al. 2024

European Journal of Pain

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BackgroundChronic pain is associated with depression and anxiety symptoms. Pain management programms, delivered face‐to‐face or via the internet, can effectively help adults manage the impacts of chronic pain. Sudden gains are defined as substantial, rapid, and lasting symptom reductions that occur between consecutive treatment sessions and have been associated with better treatment outcomes in non‐pain samples. This study examined whether adults with chronic pain report sudden gains in depression or anxiety symptoms during an 8‐week online pain management programme, and whether sudden gains were associated with better treatment outcomes for depression or anxiety. Dominant theories of sudden gains argue that therapists are required for sudden gains to be maintained and improve treatment outcomes.MethodsUsing data from a published randomized controlled trial (n = 338), sudden gains and treatment outcomes were compared across three levels of therapist guidance provided alongside the programme: weekly, optional, and self‐guided.ResultsSimilar rates of sudden gains were observed in depression (22%) and anxiety (24%) across the treatment period, and most sudden gains occurred between Weeks 1 and 2 of treatment. Therapist guidance was not associated with sudden gains; higher baseline symptom severity emerged as the only consistent predictor of sudden gain status. No significant differences in treatment outcomes for depression or anxiety symptoms between sudden gainers and non‐gainers were observed across therapist guidance conditions.ConclusionsThese results do not support an association between sudden gains in depression or anxiety symptoms and better post‐treatment outcomes, at least for adults with chronic pain.Significance StatementSudden gains in depression and anxiety symptoms were not associated with improved treatment outcomes for adults with chronic pain who participated in an online pain management programme, regardless of the level of therapist guidance provided. These findings suggest possible differences in symptom change in chronic pain samples compared to general population samples.

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A Cost-effectiveness Analysis of an Internet-delivered Pain Management Program Delivered With Different Levels of Clinician Support: Results From a Randomised Controlled Trial

Cited by 20 publications

References 41 publications

The Pain Course: a randomised controlled trial and economic evaluation of an internet-delivered pain management program

The Pain Course: a randomised controlled trial and economic evaluation of an internet-delivered pain management program

Five‐year observational study of Internet‐delivered cognitive behavioural pain management when offered as routine care by an online therapy clinic

Sudden gains in depression and anxiety during an online pain management programme for chronic pain

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