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Economic evaluation in chronic pain: a systematic review and de novo flexible economic model

Author

Listed:
  • W. Sullivan

    (BresMed Health Solutions)

  • M. Hirst

    (MundiPharma International)

  • S. Beard

    (BresMed Health Solutions)

  • D. Gladwell

    (BresMed Health Solutions)

  • F. Fagnani

    (CEMKA-EVAL)

  • J. López Bastida

    (University Castilla-La Mancha)

  • C. Phillips

    (Swansea University)

  • W. C. N. Dunlop

    (MundiPharma International)

Abstract

There is unmet need in patients suffering from chronic pain, yet innovation may be impeded by the difficulty of justifying economic value in a field beset by data limitations and methodological variability. A systematic review was conducted to identify and summarise the key areas of variability and limitations in modelling approaches in the economic evaluation of treatments for chronic pain. The results of the literature review were then used to support the development of a fully flexible open-source economic model structure, designed to test structural and data assumptions and act as a reference for future modelling practice. The key model design themes identified from the systematic review included: time horizon; titration and stabilisation; number of treatment lines; choice/ordering of treatment; and the impact of parameter uncertainty (given reliance on expert opinion). Exploratory analyses using the model to compare a hypothetical novel therapy versus morphine as first-line treatments showed cost-effectiveness results to be sensitive to structural and data assumptions. Assumptions about the treatment pathway and choice of time horizon were key model drivers. Our results suggest structural model design and data assumptions may have driven previous cost-effectiveness results and ultimately decisions based on economic value. We therefore conclude that it is vital that future economic models in chronic pain are designed to be fully transparent and hope our open-source code is useful in order to aspire to a common approach to modelling pain that includes robust sensitivity analyses to test structural and parameter uncertainty.

Suggested Citation

  • W. Sullivan & M. Hirst & S. Beard & D. Gladwell & F. Fagnani & J. López Bastida & C. Phillips & W. C. N. Dunlop, 2016. "Economic evaluation in chronic pain: a systematic review and de novo flexible economic model," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 17(6), pages 755-770, July.
    • Handle: RePEc:spr:eujhec:v:17:y:2016:i:6:d:10.1007_s10198-015-0720-y
    DOI: 10.1007/s10198-015-0720-y
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    References listed on IDEAS

    as
    1. W. Greiner & K. Lehmann & S. Earnshaw & C. Bug & R. Sabatowski, 2006. "Economic evaluation of Durogesic in moderate to severe, nonmalignant, chronic pain in Germany," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 7(4), pages 290-296, December.
    2. Lukas Radbruch & K. Lehmann & H.-H. Gockel & D. Neighbors & G. Nuyts, 2002. "Costs of opioid therapy for chronic nonmalignant pain in Germany: an economic model comparing transdermal fentanyl (Durogesic) with controlled-release morphine," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 3(2), pages 111-119, June.
    3. Bastian Haß & Juliane Lungershausen & Nadine Hertel & Barbara Poulsen Nautrup & Wioletta Kotowa & Hiltrud Liedgens, 2009. "Cost-effectiveness of strong opioids focussing on the long-term effects of opioid-related fractures: a model approach," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 10(3), pages 309-321, July.
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    More about this item

    Keywords

    Economic evaluation; Chronic pain; Transparency; Modelling assumptions;
    All these keywords.

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General

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