Boyers, Dwayne, McNamee, Paul, Clarke, Amanda, Jones, Derek, Martin, Denis, Schofield, Pat and Smith, Blair H. (2013) Cost-effectiveness of self-management methods for the treatment of chronic pain in an aging adult population: A systematic review of the literature. The Clinical Journal of Pain, 29 (4). pp. 366-375. ISSN 0749-8047 (Print), 1536-5409 (Online) (doi:https://doi.org/10.1097/AJP.0b013e318250f539)

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Abstract

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.

Item Type:	Article
Additional Information:	[1] Published ahead-of-print POST AUTHOR CORRECTIONS, 5 October 2012. [2] Published in print: April 2013. [3] Published as: Clinical Journal of Pain, (2013) Vol. 29(4), pp. 366-375. [4] The Clinical Journal of Pain is the official journal of the Eastern Pain Association.
Uncontrolled Keywords:	chronic pain, older adult, aging adult, economic evaluation, cost-effectiveness, self-management
Subjects:	R Medicine > RM Therapeutics. Pharmacology
Pre-2014 Departments:	School of Health & Social Care School of Health & Social Care > Centre for Nursing & Healthcare Research School of Health & Social Care > Department of Acute & Continuing Care
Related URLs:	Publisher Organisation
Last Modified:	14 Oct 2016 09:22
URI:	http://gala.gre.ac.uk/id/eprint/8867

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