A cost-utility analysis of multimodal pain rehabilitation in primary healthcare

Abstract

ObjectivesMultimodal rehabilitation programs (MMRPs) have been shown to be both cost-effective and an effective method for managing chronic pain in specialist care. However, while the vast majority of patients are treated in primary healthcare, MMRPs are rarely practiced in these settings. Limited time and resources for everyday activities alongside the complexity of chronic pain makes the management of chronic pain challenging in primary healthcare and the focus is on unimodal treatment. In order to increase the use of MMRPs incentives such as cost savings and improved health status in the patient group are needed. The aim of this study was to evaluate the cost-effectiveness of MMRPs for patients with chronic pain in primary healthcare in two Swedish regions. The aim of this study was to evaluate the cost-effectiveness of MMRPs at one-year follow-up in comparison with care as usual for patients with chronic pain in primary healthcare in two Swedish regions.MethodsA cost-utility analysis was performed alongside a prospective cohort study comparing the MMRP with the alternative of continuing with care as usual. The health-related quality of life (HRQoL), using EQ5D, and working situation of 234 participants were assessed at baseline and one-year follow-up. The primary outcome was cost per quality-adjusted life year (QALY) gained while the secondary outcome was sickness absence. An extrapolation of costs was performed based on previous long-term studies in order to evaluate the effects of the MMRP over a five-year time period.ResultsThe mean (SD) EQ5D index, which measures HRQoL, increased significantly (p<0.001) from 0.34 (0.32) to 0.44 (0.32) at one-year follow-up. Sickness absence decreased by 15%. The cost-utility analysis showed a cost per QALY gained of 18 704 € at one-year follow-up.ConclusionsThe results indicate that the MMRP significantly improves the HRQoL of the participants and is a cost-effective treatment for patients with chronic pain in primary healthcare when a newly suggested cost-effectiveness threshold of 19 734 € is implemented. The extrapolation indicates that considerable cost savings in terms of reduced loss of production and gained QALYs may be generated if the effects of the MMRP are maintained beyond one-year follow-up. The study demonstrates potential benefits of MMRPs in primary healthcare for both the patient with chronic pain and the society as a whole. The cost-effectiveness of MMRPs in primary healthcare has scarcely been studied and further long-term studies are needed in these settings.

Introduction of a Multimodal Pain Rehabilitation Intervention in Primary Care: A Pilot Study

“…It has been shown to be more effective than care as usual for reducing pain and disability (9) and is considered to be costsaving in terms of, for example, decreasing lost work days and HCU (10,11). Though little studied, a few studies in primary care have reported similar results (12)(13)(14)(15)(16).…”

Perspective Chapter: Interdisciplinary Pain Rehabilitation Programs – Evidence and Clinical Real-World Results

“…Eleven outcomes reflecting a BPS approach were evaluated 1 year after IPRP and 10 of these showed significant improvements although ESs were small (0.20-0.49) [92]. A cost-utility analysis indicated that IPRP in primary care was costeffective [93].…”

Comment on 'The value of interdisciplinary treatment for sickness absence in chronic pain: A nationwide register‐based cohort study'

“…The authors focus on comparisons between two sets of strategies adopted at the specialised clinics, both resulting in less sickness absence instead of highlighting the obvious: sending patients to these clinics and following their recommendations pays, both for the individual and for society. The authors, emphasising in their conclusions that the cost of the programmes is a burden for healthcare, seem to ignore the fact that the cost of healthcare is compensated by a successful decrease of sickness absence (Eklund et al, 2021;Norrefalk et al, 2008).…”