Document Detail

Cost-effectiveness of self-management methods for the treatment of chronic pain in an aging adult population: a systematic review of the literature.
MedLine Citation:
PMID:  23042472     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To determine the cost-effectiveness of self-management techniques for older populations (65 and over) with chronic pain and in the absence of such evidence to investigate this question in an aging adult population (average age 60 and over).
METHODS: Systematic review of randomized controlled trials (RCTs) with cost-effectiveness data and at least 6 months' follow-up, up to December 2010.
RESULTS: No RCT studies reported cost-effectiveness of self-management exclusively in the over 65 age group. Ten RCTs reported participants with an average age of 60 years or over and met all other inclusion criteria. All of these studies measured cost-effectiveness as cost per improvement in primary outcome, 7 of them using the Western Ontario and McMaster Universities Osteoarthritis Index score, of which 6 reported the pain dimension. Six studies reported cost per quality-adjusted life year (QALY)-gained information, with a further 1 reporting EQ-5D. In 7 studies, relative to usual care, self-management was effective, and in the remaining 3 studies, there was no significant difference. Among those reporting cost per QALY-gained results, self-management did not lead to statistically significant QALY gains relative to usual care (with only one exception). Eight studies suggested that the cost of developing and delivering self-management interventions may be partly offset by savings from reduced subsequent health care resource use.
CONCLUSIONS: Self-management is effective among an aging adult population (mean age over 60) with chronic pain and may be cost-effective when outcomes are measured using the Western Ontario and McMaster Universities Osteoarthritis Index pain score. Cost-effectiveness is less certain when measured using the QALY metric. Uncertainty over conclusions regarding cost-effectiveness exists partly due to lack of information regarding societal willingness to pay for pain improvement. There is a need for large multicentred high-quality RCTs to confirm the findings of this review exclusively among older aged populations, such as those who have already reached the statutory retirement age.
Dwayne Boyers; Paul McNamee; Amanda Clarke; Derek Jones; Denis Martin; Pat Schofield; Blair H Smith
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  The Clinical journal of pain     Volume:  29     ISSN:  1536-5409     ISO Abbreviation:  Clin J Pain     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-03-04     Completed Date:  2013-08-26     Revised Date:  2014-02-20    
Medline Journal Info:
Nlm Unique ID:  8507389     Medline TA:  Clin J Pain     Country:  United States    
Other Details:
Languages:  eng     Pagination:  366-75     Citation Subset:  IM    
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MeSH Terms
Aged, 80 and over
Chronic Pain / economics,  therapy*
Cost-Benefit Analysis
Middle Aged
Pain Management / economics*
Quality-Adjusted Life Years
Self Care / economics*
Grant Support
G0900684//Medical Research Council; //Biotechnology and Biological Sciences Research Council; //Chief Scientist Office; //Medical Research Council

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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