Economics of Pain Management Testing

Chronic pain management accounts for a significant portion of health-care costs and has important societal implications, including the increasing availability of prescription narcotics. Urine drug testing (UDT) is an effective tool to monitor adherence to prescription medications and has been recommended by several guidelines. Furthermore, the clinical and technical benefits of UDT using definitive testing methods such as LC-MS/MS are well documented. However, the cost-effectiveness is not well studied.

In this article, we discuss the cost considerations associated with different UDT methodologies, including point-of-care immunoassays, laboratory-based immunoassays, and definitive testing by LC-MS/MS. The costs of reagents, consumables, instrumentation, service, and labor are described, as well as the opportunity each methodology offers in relation to test utilization and clinical cost savings. An overview of how to assess the cost-effectiveness of insourcing definitive testing and how to generate a comprehensive insourcing proposal is provided. Billing options for UDT and the recent changes in current procedural terminology codes are also discussed.

Given the current health-care environment, additional studies and recommendations that incorporate the cost-effectiveness of definitive testing to monitor compliance in pain management are needed. The decreasing cost of mass spectrometry, the increasing visibility of the value of the laboratory medicine, the new prescriber regulations for opioids, and the push to change reimbursement for definitive UDT will all contribute to the cost-effectiveness of definitive LC-MS/MS to monitor patients with chronic pain.