First EFIC® Symposium Societal Impact of Pain - SIP

86
Antoni Sicras Mainar
Dr. Antoni Sicras Mainar
Directorate of Planning Badalona Serveis Assistencials
Badalona, Barcelona (Spain)
A retrospective study to evaluate the morbidity
profiles, the therapeutic options, and
their cost-effectiveness in patients receiving
regular treatment for chronic pain
Sicras, A1, Navarro, R,1 Villoria, J2
1 Badalona Servei Assistencials, Barcelona
(Spain), 2Medixact, Madrid (Spain)
Introduction: chronic pain is gaining importance
as a major cost factor in health care.
Objectives: to identify patient morbidity group
profiles based on treatment setting (pain unit,
hospital), and complete the frequencies of patients
with similar morbidity profiles but different
analgesic prescription. The profiles identified
were used in cost-effectiveness and
cost-driver analyses.
Methods: a public database from local authorities
(Badalona) was selected. Data retrieved
from patients aged over 44 who called at least
once in any of the health care facilities within
the study area during 2008 had a chronic condition
(i.e. lasting more than 6 months), and
were regularly prescribed analgesics. analgesics.
Information gathered included sociodemographic
and clinical data, resource use,
and comorbidities (Charlson index). Data were
classified according to prescription of Step 1
and/or 2 vs. Step 3 analgesics. Proxy measures
of effectiveness were used (treatment in
a pain unit, treatment in a hospital, average
no. of analgesic (non-opioid) drugs per patient,
average no. of analgesic (opioid) drugs per
patient, and average days spent in hospital per
patient) in the absence of direct measures. For
cost-effectiveness analysis, direct health care
costs and indirect costs associated with work
days missed because of health problems were
calculated. Patients treated in hospital or in a
pain unit were considered to be inadequately
treated if they did not receive at least one Step
3 analgesic. An adjusted comparison of the
costs prompted by inadequately treated patients
with those of the remaining sample was
made by means of multiple linear regressions.
Results: a total of 18,157 patients met the inclusion
criteria. Only 410 (2.3%) were on Step
3 analgesics. Direct health-care costs were
greater in patients on Step 3 analgesics (mean
[SD]: 5,505.6 [5,046.4] €) than in patients on
Step 1 and/or 2 analgesics (2,407.4 [2,436.2]
€), but not indirect costs (258.5 [1,578.4] €
vs. 279.5 [1,423.6] €, respectively). Using the
indicators of effectiveness of in-hospital or
treatment in a pain unit, on average 2.3% and
20.1% of patients were identified who were inadequately
treated with Step 1 and/or 2 analgesics.
Regression analyses revealed greater
direct costs in patients undertreated after adjusting
by age, gender, number of resources
employed and comorbidities. In opposition, indirect
costs were lower among patients inadequately
treated than in the remaining sample.
Conclusions: Step 3 analgesics are underutilized
in this sample of patients with chronic
conditions causing pain. In the absence of direct
measures of effectiveness, this research suggests
that about 1/5 of these patients could
be inadequately treated with Step 1 and/or 2
analgesics, as they matched the profile of those
receiving Step 3 analgesics. Step 3 analgesics
were reserved for complex situations. Patients
classified as inadequately treated prompted
greater direct health-care costs than those
considered to receive adequate treatment for
their disease status.