The cost effectiveness of pain management strategies in advanced cancer

Abstract

Objectives: Uncontrolled pain in advanced cancer is a common problem and has significant impact on individuals’ quality of life and use of healthcare resources. Interventions to help manage pain at the end of life are available but there is limited economic evidence to support their wider implementation. We conducted a case study economic evaluation of two pain selfmanagement interventions (PainCheck and Tackling Cancer Pain Toolkit (TCPT)) compared to usual care. Methods: We generated a decision-analytic model to facilitate the evaluation. This modelled the survival of individuals at the end of life as they moved through pain severity categories. Intervention effectiveness was based on published meta-analyses results. The evaluation was conducted from the perspective of the UK health service provider and reported cost per quality-adjusted life year (QALY). Results: PainCheck and TCPT were cheaper (respective incremental costs -GBP148 [- EUR168.53] and -GBP474 [-EUR539.74]) and more effective (respective incremental QALYs of 0.010 and 0.013) than usual care. There was a 65% and 99.5% chance of costeffectiveness for PainCheck and TCPT, respectively. Results were relatively robust to sensitivity analyses. The most important driver of cost-effectiveness was level of pain reduction (intervention effectiveness). Although cost savings were modest per patient these were considerable when accounting for the number of potential intervention beneficiaries. Conclusion: Educational and monitoring/feedback interventions have the potential to be costeffective. Economic evaluations based on estimates of effectiveness from published metaanalyses and using a decision modelling approach can support commissioning decisions and implementation of pain management strategies.