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.
| Original language | English |
|---|---|
| Pages (from-to) | 366-375 |
| Number of pages | 10 |
| Journal | Clinical Journal of Pain |
| Volume | 29 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - Apr 2013 |
Funding
EoPIC is a collaborative project between the Universities of Aberdeen, Dundee, Northumbria, and Teesside and is funded by the Life Long Health and Well-being (LLHW)-research initiative for healthy ageing. LLHW is funded by Biotechnology and Biological Sciences Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Medical Research Council, Chief Scientist Office of the Scottish Government Health Directorates, National Institute for Health Research/The Department of Health, The Health and Social Care Research & Development of the Public Health Agency (Northern Ireland), and Wales Office of Research and Development for Health and Social Care, Welsh Assembly Government. The Health Economics Research Unit is supported by the Chief Scientist Office of the Scottish Government Health Directorates. Disclosures: B. H. S. is conducting research on pain funded by an unrestricted educational grant from Pfizer UK Ltd. The authors declare no conflict of interest.
Keywords
- chronic pain
- older adult
- aging adult
- economic evaluation
- cost-effectiveness
- self-management
- general-population
- knee pain
- osteoarthritis
- interference
- community
- exercise
- program
- EUROQOL
- EQ-5D
- life
