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Cost-Effectiveness of Remote Cognitive-Behavioral-Based Therapy for Chronic Pain Among People With High-Impact
John F Dickerson1, Maureen O'Keefe-Rosetti1, Meghan Mayhew1
1Kaiser Permanente Center for Health Research, Portland, OR, USA.
Objectives:
Assess cost-effectiveness from the health plan perspective comparing 2 remote cognitive-behavioral-therapy-for-chronic-pain-based interventions (1) pain TRAINER online program and (2) health coach-led telehealth program relative to usual care (UC) and each other.
Methods:
Cost-effectiveness analysis includes N = 1725 individuals with high-impact chronic pain from 3 Kaiser Permanente sites of RESOLVE randomized clinical trial. Costs were calculated for all healthcare and pain-related services. Clinical outcomes at 1-year included: quality-adjusted life-years (QALY) and minimal clinically important difference (MCID) in pain severity score (≥30% improvement).
Results:
Both cognitive-behavioral-therapy-for-chronic-pain-based interventions had significantly higher QALYs (painTRAINER: Adj Diff. = 0.035, P < .001; health coach: Adj Diff. = 0.041, P < .001) and proportion achieving MCID (painTRAINER: Adj Diff. = 14.1%, P < .001; health coach: Adj Diff. = 12.2%, P < .001) than UC. painTRAINER was dominant relative to UC (ie, less expensive and more effective) for both QALYs and MCIDs. The incremental cost-effectiveness ratio for health coach vs UC was $19 009 per QALY and $6267 per MCID. The incremental cost-effectiveness ratio for health coach vs painTRAINER was $244 446 per QALY. Net benefit regression identified painTRAINER as the cost-effective choice across all willingness-to-pay levels. Sensitivity analyses, excluding overly influential outliers, demonstrated consistent results, and that health coach vs painTRAINER was cost-effective above willingness-to-pay of $120 000 per QALY.
Conclusion:
Analyses showed that both the painTRAINER and health coach programs are highly cost-effective relative to UC. Compared with each other, painTRAINER is more cost-effective than the health coach program.
