Highlights
- •Estimated annual health care costs were $16,443 per child.
- •Total health care costs significantly decreased across both treatment conditions.
- •Research to determine patterns and drivers of health care costs is needed.
Abstract
The economic burden of pediatric chronic pain is high, with an estimated annual cost
of $19.5 billion. Little is known about whether psychological treatment for pediatric
chronic pain can alter health care utilization for youth. The primary aim of this
secondary data analysis was to evaluate the effect of adjunctive internet cognitive-behavioral
therapy intervention or adjunctive internet education on health care-related economic
costs in a cohort of adolescents with chronic pain recruited from interdisciplinary
pain clinics across the United States. For the full sample, health care expenditures
significantly decreased from the year before the intervention to the year after the
intervention. Results indicated that the rate of change in health care costs over
time was not significantly different between the internet cognitive-behavioral therapy
intervention and adjunctive internet education groups. Further research is needed
to replicate these findings and determine patterns and drivers of health care costs
for youth with chronic pain evaluated in interdisciplinary pain clinics and whether
psychological treatments can alter these patterns. This trial was registered at clinicaltrials.gov (identifier NCT01316471).
Perspective
Health care expenditures significantly decreased in youth with chronic pain from the
year before initiating treatment to the following year in both intervention conditions,
adjunctive internet cognitive-behavioral therapy and adjunctive internet education.
Contrary to our hypothesis, the rate of change in health care costs over time was
not significantly different between intervention conditions.
Key words
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References
- United States Medical Expenditure Panel Survey.Agency for Healthcare Research and Quality, Rockville, United States2010
- Revisiting the behavioral model and access to medical care: Does it matter?.J Health Soc Behav. 1995; 36: 1-10
- Racial and ethnic disparities in pain: Causes and consequences of unequal care.J Pain. 2009; 10: 1187-1204
- Urban adolescents with intellectual disability and challenging behaviour: Costs and characteristics during transition to adult services.Health Soc Care Community. 2013; 21: 283-292
- National profile of nonemergent pediatric emergency department visits.Pediatrics. 2010; 125: 454-459
- Modeling risk using generalized linear models.J Health Econ. 1999; 18: 153-171
- Simplified estimation from censored normal samples.Ann Mat Stat. 1960; 31: 385-391
- Psychological therapies for the management of chronic and recurrent pain in children and adolescents.Cochrane Database Syst Rev. 2014; (CD003968)
- Clinical service use as people with attention deficit hyperactivity disorder transition into adolescence and adulthood: A prospective longitudinal study.BMC Health Serv Res. 2016; 16: 248
- The cost-effectiveness of intensive interdisciplinary pediatric chronic pain rehabilitation.J Pediatr Psychol. 2016; 41: 849-856
- The distinction between cost and charges.Ann Intern Med. 1982; 96: 102-109
- Adolescent and parent treatment goals in an internet-delivered chronic pain self-management program: Does agreement of treatment goals matter?.J Pediatr Psychol. 2017; 42: 657-666
- Systematic review and meta-analysis of psychological therapies for children with chronic pain.J Pediatr Psychol. 2014; 39: 763-782
- Psychological therapies (remotely delivered) for the management of chronic and recurrent pain in children and adolescents.Cochrane Database Syst Rev. 2015; (CD011118)
- The economic costs of chronic pain among a cohort of treatment-seeking adolescents in the United States.J Pain. 2014; 15: 925-933
- Health care expenditures associated with pediatric pain-related conditions in the United States.Pain. 2015; 156: 951-957
- 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
- Healthcare utilization and indirect burden among families of pediatric patients with chronic pain.J Musculoskelet Pain. 2008; 16: 155-164
- Annual costs of care for pediatric irritable bowel syndrome, functional abdominal pain, and functional abdominal pain syndrome.J Pediatr. 2015; 167 (e1102): 1103-1108
- Racial and socioeconomic disparities in disabling chronic pain: Findings from the health and retirement study.J Pain. 2017; 18: 1459-1467
- Longitudinal change in parent and child functioning after internet-delivered cognitive-behavioral therapy for chronic pain.Pain. 2017; 158: 1992-2000
- Brief telephone-delivered cognitive behavioral therapy targeted to parents of children with functional abdominal pain: A randomized controlled trial.Pain. 2017; 158: 618-628
- Effects of a cognitive behavioral therapy intervention trial to improve disease outcomes in children with inflammatory bowel disease.Inflamm Bowel Dis. 2016; 22: 2134-2148
- Estimating costs in cost-effectiveness analysis.in: Gold M. Siegel J.E. Russell L.B. Weinstein M.C. Cost Effectiveness in Health and Medicine. Oxford University Press, New York1996: 176-213
- A cost-analysis of an interdisciplinary pediatric chronic pain clinic.J Pain. 2017; 19: 158-165
- Healthcare service use in adolescents with non-specific musculoskeletal pain.Acta Paediatr. 2010; 99: 1224-1228
- Internet-delivered cognitive-behavioral treatment for adolescents with chronic pain and their parents: A randomized controlled multicenter trial.Pain. 2016; 157: 174-185
- Trajectories of change during a randomized controlled trial of internet-delivered psychological treatment for adolescent chronic pain: How does change in pain and function relate?.Pain. 2015; 156: 626-634
- Inpatient burden of childhood functional GI disorders in the USA: An analysis of national trends in the USA from 1997 to 2009.Neurogastroenterol Motil. 2015; 27: 684-692
- Insights in the use of health care services in chronic benign pain in childhood and adolescence.Pain. 2001; 94: 205-213
- Economic cost of severe antisocial behaviour in children–and who pays it.Br J Psychiatry. 2006; 188: 547-553
- Health care utilization and cost in children and adolescents with chronic pain: Analysis of health care claims data 1 year before and after intensive interdisciplinary pain treatment.Clin J Pain. 2017; 33: 767-776
- The economic impact of chronic pain in adolescence: Methodological considerations and a preliminary costs-of-illness study.Pain. 2005; 119: 183-190
- Stata Statistical Software: Release 12.StataCorp LP, College Station, TX2011
- Racial/ethnic disparities in the assessment and treatment of pain: psychosocial perspectives.Am Psychol. 2014; 69: 131-141
- Patterns and predictors of health service utilization in adolescents with pain: comparison between a community and a clinical pain sample.J Pain. 2011; 12: 747-755
- Consumer Price Index.(Available at:)http://www.bls.gov/cpi/Date accessed: April 10, 2017
- Determining the cost of pharmaceuticals for a cost-effectiveness analysis.(Available at:)https://www.herc.research.va.gov/include/page.asp?id=pharmaceutical-costsDate accessed: April 10, 2017
- Veterans Affairs Federal Supply Schedule Pharmaceutical Pricing.(Available at:)https://www.va.gov/oal/business/fss/pharmPRices.aspDate accessed: April 10, 2017
- Complementary and alternative medicine use and cost in functional bowel disorders: A six month prospective study in a large HMO.BMC Complement Altern Med. 2008; 8: 46
- Abdominal pain in British young people: Associations, impairment and health care use.J Psychosom Res. 2012; 73: 437-442
Article info
Publication history
Published online: March 22, 2018
Accepted:
March 7,
2018
Received in revised form:
February 12,
2018
Received:
January 2,
2018
Footnotes
An earlier version of this research was presented at the American Pain Society 36th Annual Scientific Meeting, and published as a scientific abstract (Law E.F., Groenewald C., Zhou C., Palermo, M.: Interdisciplinary pain clinic treatment may reduce health care utilization among youth with chronic pain. J Pain 18:S43, 2017).
This research was supported by the National Institutes of Health, including Grant R01HD062538 from the Eunice Kennedy Shriver National Institute of Child Health, Behavior and Development (PI: Palermo) and Grant K23NS089966 from the National Institutes of Health/National Institute of Neurological Disorders and Stroke (PI: Law).
The authors have no conflicts of interest to declare.
Identification
Copyright
© 2018 by the American Pain Society
