Treatment profiles and costs of patients with chronic pain in the population setting

BACKGROUND The purpose of this study was to gather information about analgesic drug therapy in patients with chronic pain and perform cost estimates to guide future cost-effectiveness research in the area. METHODS Data from patients aged 44 years and over suffering from any chronic condition and receiving regular analgesic drug therapy (for ≥6 months) who attended health care facilities within the area of Badalona during 2008 were collected in a retrospective study. Morbidity profiles were defined according to treatment setting (pain unit, hospital), World Health Organization analgesic step (1-2 versus 3), and a raw cost model based on resource use and work absenteeism was applied. Patients attending the pain unit or the hospital were considered undertreated if they were on step 1-2 analgesics. Multiple regression was used to compare costs between undertreated and non-undertreated patients among those attending the pain unit or the hospital. RESULTS Only 410 of 18,157 patients ascertained (2.3%) were on step 3 analgesics. Their direct costs were greater than those of patients on step 1-2 analgesics, although the opposite was true regarding indirect costs. Of patients seen in the pain unit and in the hospital, 2.3% and 20.1%, respectively, were considered undertreated. Regression analyses revealed even greater costs in the subgroup of undertreated patients. CONCLUSION Step 3 analgesics are barely used. Up to one-fifth of patients may be undertreated, generating greater costs than those considered to be properly treated. Regression analyses did not clarify the proportion of their cost excess that was attributable to undertreatment.