TY - JOUR
T1 - The pain course
T2 - a randomised controlled trial and economic evaluation of an internet-delivered pain management program
AU - Dear, Blake F.
AU - Karin, Eyal
AU - Fogliati, Rhiannon
AU - Dudeney, Joanne
AU - Nielssen, Olav
AU - Gandy, Milena
AU - Staples, Lauren
AU - Scott, Amelia J.
AU - Heriseanu, Andreea I.
AU - Bisby, Madelyne A.
AU - Hathway, Taylor
AU - Titov, Nickolai
AU - Schroeder, Liz
N1 - Copyright © 2021 International Association for the Study of Pain.
PY - 2022/7
Y1 - 2022/7
N2 - There is interest in the potential of Internet-delivered programs to cost-effectively increase access to pain management for people with chronic pain. However, few large-scale clinical and economic evaluations have been undertaken. Using a randomised controlled trial design, the current study (n = 659) examined the clinical efficacy, cost-effectiveness, and cost utility of an Internet-delivered pain management program for people with mixed chronic pain conditions when delivered with optional clinician support. The treatment group reported significant improvements in disability, depression, anxiety, average pain intensity, and quality-adjusted life years (QALYs), compared with control, and exhibited relatively high levels of treatment engagement and satisfaction. Each additional clinical improvement (defined as ≥ 30% improvement) produced by the intervention, over control, was associated with a cost of $48, $27, $38, and $83 for disability, depression, anxiety, and average pain intensity, respectively. Gaining one QALY was associated with a cost of $152 or $11,910 per QALY when an 80% probability criterion for cost utility was applied. The program itself was associated a relatively small, fixed, cost per patient but was not cost saving over the brief intervention period. The findings support the clinical efficacy and cost-effectiveness of Internet-delivered programs with "on demand" clinician support as a way to increase access to pain management. Key limitations of the current study include the use of a waitlist-control group, a short follow-up period, and the focus on governmental healthcare costs. Further evaluation of these programs is necessary if they are scaled up and offered as routine care.
AB - There is interest in the potential of Internet-delivered programs to cost-effectively increase access to pain management for people with chronic pain. However, few large-scale clinical and economic evaluations have been undertaken. Using a randomised controlled trial design, the current study (n = 659) examined the clinical efficacy, cost-effectiveness, and cost utility of an Internet-delivered pain management program for people with mixed chronic pain conditions when delivered with optional clinician support. The treatment group reported significant improvements in disability, depression, anxiety, average pain intensity, and quality-adjusted life years (QALYs), compared with control, and exhibited relatively high levels of treatment engagement and satisfaction. Each additional clinical improvement (defined as ≥ 30% improvement) produced by the intervention, over control, was associated with a cost of $48, $27, $38, and $83 for disability, depression, anxiety, and average pain intensity, respectively. Gaining one QALY was associated with a cost of $152 or $11,910 per QALY when an 80% probability criterion for cost utility was applied. The program itself was associated a relatively small, fixed, cost per patient but was not cost saving over the brief intervention period. The findings support the clinical efficacy and cost-effectiveness of Internet-delivered programs with "on demand" clinician support as a way to increase access to pain management. Key limitations of the current study include the use of a waitlist-control group, a short follow-up period, and the focus on governmental healthcare costs. Further evaluation of these programs is necessary if they are scaled up and offered as routine care.
KW - pain management
KW - chronic pain
KW - Randomised Controlled Trial
KW - economic evaluation
KW - cost-effectiveness
KW - internet
KW - online
KW - cognitive behaviour therapy
UR - http://www.scopus.com/inward/record.url?scp=85126031734&partnerID=8YFLogxK
U2 - 10.1097/j.pain.0000000000002507
DO - 10.1097/j.pain.0000000000002507
M3 - Article
C2 - 34609359
SN - 0304-3959
VL - 163
SP - 1388
EP - 1401
JO - Pain
JF - Pain
IS - 7
ER -