慢性疼痛是一种广泛的疾病,会给社会带来很多痛苦和巨大的代价。近几十年来,疼痛康复计划(REH)在瑞典的慢性疼痛治疗中占主导地位。尽管射频神经切断术(RFN)在最近的研究中具有成本效益,REH的长期健康和经济影响尚未得到全面评估。
■用倾向评分加权的观察性研究来比较RFN和REH。
■2010年至2016年评估和治疗的患者符合资格;15,357例接受REH,254例接受RFN。患者数据与来自国家登记册的关联数据相结合。我们使用倾向评分加权来模拟使用基线性别的随机对照试验,年龄,和基线健康相关生活质量作为协变量。
■两组的健康相关生活质量均有显著改善,REH后1年和2年的0.164年和0.352年质量调整寿命年(QALYs),RFN后的QALY为0.186和0.448。RFN的评估和诊断程序稍微昂贵一些,但REH的治疗费用更高。两组治疗后病假减少,特别是在RFN之后。REH后1年的每QALY成本为〜121,633美元,根据瑞典国家卫生和福利委员会的说法,这被认为“非常昂贵”。相比之下,RFN的成本为13715美元,在“中等”范围内。两年后,每个QALY获得的成本在REH的“中等”范围内,在RFN的“低”范围内。
■RFN和REH改善了与健康相关的生活质量,与RFN的显著更大的改进。根据倾向评分加权,治疗方法具有可比性,RFN在中低范围内具有成本效益,而REH被认为是非常昂贵的适度。将RFN从目前的2%扩大到瑞典的25%,每年可以节省2120万美元的医疗支出。
UNASSIGNED: Chronic pain is a widespread condition that causes much suffering and significant cost to society. Pain rehabilitation programs (REH) have dominated the treatment of chronic pain in Sweden in recent decades. Although radiofrequency neurotomy (RFN) was cost-effective in recent studies, the long-term health and economic effects of REH have not been comprehensively evaluated.
UNASSIGNED: Observational study with propensity score weighting to compare RFN and REH.
UNASSIGNED: Patients assessed and treated between 2010 and 2016 were eligible; 15,357 underwent REH and 254 underwent RFN. Patient data were combined with linked data from national registers. We used propensity score weighting to mimic a randomized controlled trial using baseline gender, age, and baseline health-related quality of life as covariates.
UNASSIGNED: Health-related quality of life improved significantly in both groups, by 0.164 and 0.352 quality-adjusted life years (QALYs) at 1 and 2 years after REH, and by 0.186 and 0.448 QALYs after RFN. The assessment and diagnostic procedures were slightly more expensive for RFN, but the treatment costs were greater for REH. Sick leave decreased after treatment in both groups, particularly after RFN. The cost per QALY gained 1 year after REH was ∼121,633 USD, which is considered \"very expensive\" according to the Swedish National Board of Health and Welfare. By comparison, the cost of RFN was ∼13,715 USD, in the \"moderate\" range. After 2 years the cost per QALY gained was in the \"moderate\" range for REH and \"low\" for RFN.
UNASSIGNED: RFN and REH improved health-related quality of life, with significantly greater improvement with RFN. The treatments were comparable based on propensity score weighting, and RFN was cost-effective in the moderate to low range, whereas REH was considered very expensive to moderate. Expanding RFN from 2% currently to 25% of the treatments given in Sweden could save ∼21.2 million USD annually in healthcare expenditure.