The pain course: a randomised controlled trial and economic evaluation of an internet-delivered pain management program

Blake F. Dear*, Eyal Karin, Rhiannon Fogliati, Joanne Dudeney, Olav Nielssen, Milena Gandy, Lauren Staples, Amelia J. Scott, Andreea I. Heriseanu, Madelyne A. Bisby, Taylor Hathway, Nickolai Titov, Liz Schroeder

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

14 Citations (Scopus)
32 Downloads (Pure)

Abstract

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.

Original languageEnglish
Pages (from-to)1388–1401
Number of pages14
JournalPain
Volume163
Issue number7
Early online date4 Oct 2021
DOIs
Publication statusPublished - Jul 2022

Keywords

  • pain management
  • chronic pain
  • Randomised Controlled Trial
  • economic evaluation
  • cost-effectiveness
  • internet
  • online
  • cognitive behaviour therapy

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