Description and Predictors of Direct and Indirect Costs of Pain Reported by Cancer Patients

Abstract

The purpose of this study was to describe direct and indirect costs associated with pain in cancer patients and to examine potential predictors of these costs. The study surveyed cancer outpatients about direct costs resulting from pain-related hospitalizations, emergency department visits, physician office visits, and use of analgesic medications and indirect costs related to money spent on pain-related transportation, complementary methods to improve pain management, educational materials, over-the counter medication, domestic support, and childcare. Furthermore, the study examined age, marital status, race, income level, pain severity, pain interference, and presence of breakthrough pain as predictors of direct and indirect costs. Three hundred and seventy-three cancer outpatients were sampled. One hundred and forty-four cancer patients (39%) reported experiencing cancer-related pain and completed the study questionnaires. Seventy-six percent (76%) of the patients had experienced at least one pain-related cost, resulting in an average monthly direct cost of US$ 891/month per patient. Sixty-nine percent (69%) of patients had experienced some type of direct medical cost due to pain, resulting in an average total direct pain-related cost of US$ 825/month per patient. Fifty-seven percent (57%) of patients reported incurring at least one indirect pain-related expense for an average indirect cost of US$ 61/month per patient. Higher pain intensity, greater pain interference, and presence of breakthrough pain predicted higher direct and indirect medical expenses. Younger age and lower income level also predicted higher direct medical expenses.

Change in Cancer Pain Management in Korea Between 2001 and 2006: Results of Two Nationwide Surveys

“…Untreated or undertreated pain impairs physical and psychological health, functional status, and quality of life, in addition to increasing the economic cost. 3,4 Severe pain also is associated with more medical complications, refusal to receive proper treatment, and increased desire for hastened death. 5,6 Following the widespread dissemination of the three-level ladder of pain management by the World Health Organization (WHO), 7 opioid treatment has become widely accepted as the first-line approach for cancer-related pain, yielding satisfactory relief in as many as 90% of patients.…”

Efficiency of Intranasal Fentanyl in Patients with Breakthrough Cancer Pain in Daily Practice - Results of the German Non-Interventional Study with Instanyl® (GENISIS)

“…BTcP is a frequent complication of cancer especially in advanced stages of the disease, not only associated with severe detrimental effects on daily functioning, quality-of-life and social relationships [1,8], but also responsible for significant incremental direct as well as indirect costs [10,11,36,37].…”

“…prescription costs, costs for social services and nursing assistance), and indirect expenditures (e.g. transportation costs), for the health service, the patients and their care-givers [11,37]. The fact that the use of INFS for the treatment of BTcP in a highly impaired group of cancer patients translates almost immediately into clinically relevant improvements, underlines not only the potential of this new treatment option for daily practice, but also the detrimental effects of un-or insufficiently controlled BTcP.…”

Erfahrungen von Tumorpatienten mit Durchbruchschmerzen und medikamentösen Behandlungen

“…In der palliativmedizinischen Literatur werden Prävalenzen des Durchbruchschmerzes zwischen 23 [5] und 93% [23] aller Tumorpatienten berichtet, wobei sich im Durchschnitt der bisher publizierten Ergebnisse Anteile von ca. 60-70% schätzen lassen.…”

“…Zusätzlich entstehen höhere Gesundheitskosten durch vermehrte und längere Krankenhausaufenthalte der betroffenen Patienten [1,5].…”