The application of economic evaluation methods in the chronic pain medicine literature

BACKGROUND: The relative efficiency of a health care intervention or health status improvement realized for a given amount of resources expended can be determined using cost-effectiveness analysis or cost-utility analysis. METHODS: An extensive chronic pain-focused search was undertaken of the MEDLINE, EMBASE, and SCI-EXPANDED databases. A total of 1822 unique citations were generated, with 142 studies subsequently categorized as incorporating one of seven recognized types of health care economic evaluation. RESULTS: Of the 142 identified chronic pain-related economic evaluations published between 1988 and 2006, 30 incorporated a cost-effectiveness analysis and 29 incorporated a cost-utility analysis. The data are consistent with the previously reported chronological pattern of an increased overall diffusion of cost-utility analysis studies from the general medical and health services research literature into the medical subspecialty journals. However, only a few studies combined the economic analysis alongside a randomized controlled trial, the economic end-points in the trials had limited time horizons, and there was failure to address the protracted costs versus benefits of treating long-term and often recurrent chronic pain conditions. CONCLUSIONS: Although it would appear worthwhile for researchers and clinicians to consider cost-effectiveness analysis and cost-utility analysis in their trial designs and treatment algorithms for chronic pain conditions, methodological improvements can be made in trial designs.