Highlights
- •Pediatric chronic pain is a costly condition requiring interdisciplinary treatment.
- •An interdisciplinary pain clinic reduced inpatient and emergency department visits.
- •Pain clinic participation resulted in hospital cost savings of $36,228/patient/year.
- •Pain clinic participation resulted in insurance cost savings of $11,482/patient/year.
Abstract
Chronic pain is characterized by high rates of functional impairment, health care
utilization, and associated costs. Research supports the use of comprehensive, interdisciplinary
treatment approaches. However, many hospitals hesitate to offer this full range of
services, especially to Medi-Cal/Medicaid patients whose services are reimbursed at
low rates. This cost analysis examines the effect on hospital and insurance costs
of patients' enrollment in an interdisciplinary pediatric pain clinic, which includes
medication management, psychotherapy, biofeedback, acupuncture, and massage. Retrospective
hospital billing data (inpatient/emergency department/outpatient visits, and associated
costs/reimbursement) from 191 consecutively enrolled Medi-Cal/Medicaid pediatric patients
with chronic pain were used to compare 1-year costs before initiating pain clinic
services with costs 1 year after. Pain clinic patients had significantly fewer emergency
department visits, fewer inpatient stays, and lower associated billing, compared with
the year before without interdisciplinary pain management services. Cost savings to
the hospital of $36,228 per patient per year and to insurance of $11,482 per patient
per year were found even after pain clinic service billing was included. Analyses
of pre-pain clinic costs indicate that these cost reductions were likely because of
clinic participation. Findings provide economic support for the use of interdisciplinary
care to treat pediatric chronic pain on an outpatient basis from a hospital and insurance
perspective.
Perspective
This article presents a cost analysis of an interdisciplinary pediatric pain outpatient
clinic. Findings support the incorporation of a comprehensive treatment approach that
can reduce costs from a hospital and insurance perspective over the course of just
1 year.
Key words
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References
- Analysis of cost data in randomized trials: An application of the non-parametric bootstrap.Stat Med. 2000; 19: 3219-3236
- Multidisciplinary programs for management of acute and chronic pain in children.in: Schechter N.L. Berde C.B. Yaster M. Pain in Infants, Children and Adolescents. Lippincott Williams & Wilkins, Philadelphia2003: 471-486
- The prognosis of childhood headache: A 20-year follow-up.Arch Pediatr Adolesc Med. 2005; 159: 1157-1160
- Chronic pain and psychopathology: Research findings and theoretical considerations.Psychosom Med. 2002; 64: 773-786
- An introduction to the bootstrap.CRC press, Boca Raton, FL1994
- The cost-effectiveness of intensive interdisciplinary pediatric chronic pain rehabilitation.J Pediatr Psychol. 2016; 41: 849-856
- The economic costs of pain in the United States.J Pain. 2012; 13: 715-724
- Evidence-based scientific data documenting the treatment and cost-effectiveness of comprehensive pain programs for chronic nonmalignant pain.J Pain. 2006; 7: 779-793
- Psychosocial care in the pediatric hospital: The need for scientific validation of clinical and cost effectiveness.Gen Hosp Psychiatry. 1995; 17: 228-234
- The biopsychosocialspiritual impact of chronic pain, chronic illness, and physical disabilities in adolescence.Curr Pain Headache Rep. 2015; 19: 51
- Pain, fatigue and health-related quality of life in children and adolescents with chronic pain.Clin J Pain. 2009; 25: 407-412
- The economic costs of chronic pain among a cohort of treatment-seeking adolescents in the United States.J Pain. 2014; 15: 925-933
- Systematic review on intensive interdisciplinary pain treatment of children with chronic pain.Pediatrics. 2015; 136: 115-127
- Inpatient-based intensive interdisciplinary pain treatment for highly impaired children with severe chronic pain: Randomized controlled trial of efficacy and economic effects.Pain. 2014; 155: 118-128
- Are complementary therapies and integrative care cost-effective? A systematic review of economic evaluations.BMJ Open. 2012; 2: e001046
- Healthcare utilization and indirect burden among families of pediatric patients with chronic pain.J Musculoskelet Pain. 2008; 16: 155-164
- Treatment of children with unexplained chronic pain.Lancet. 2006; 367: 380
- The epidemiology of chronic pain in children and adolescents revisited: A systematic review.Pain. 2011; 152: 2729-2738
- Psychiatric morbidity in children with medically unexplained chronic pain: Diagnosis from the pediatrician's perspective.Pediatrics. 2006; 117: 889-897
- Problems and barriers of pain management in the emergency department: Are we ever going to get better.J Pain Res. 2008; 2: 5-11
- Assessment and management of children with chronic pain: A position statement from the American Pain Society.American Pain Society, Chicago, IL2013
- Impact of recurrent and chronic pain on child and family daily functioning: A critical review of the literature.J Dev Behav Pediatr. 2000; 21: 58-69
- Pain in children and adolescents: A common experience.Pain. 2000; 87: 51-58
- Insights in the use of health care services in chronic benign pain in childhood and adolescence.Pain. 2001; 94: 205-213
- The frequency, trajectories and predictors of adolescent recurrent pain: A population-based approach.Pain. 2008; 138: 11-21
- Complex chronic pain in children, interdisciplinary treatment.in: Schmidt R.F. Willis W.D. Encyclopedic Reference of Pain. Springer-Verlag, Heidelberg2006
- Functional abdominal pain in childhood and adolescence increases risk for chronic pain in adulthood.Pain. 2010; 150: 568-572
- Integrative care for pediatric patients with pain.J Altern Complement Med. 2013; 19: 627-632
Article info
Publication history
Published online: October 17, 2017
Accepted:
September 27,
2017
Received in revised form:
August 29,
2017
Received:
June 9,
2017
Footnotes
Dr. Herman received reimbursement for consultation time.
The authors have no conflicts of interest to declare.
Identification
Copyright
© 2017 by the American Pain Society
