Jessica S Merlin1,2, Andrew O Westfall1,3, Mallory O Johnson4, Robert D Kerns5,6, Matthew J Bair7,8,9, Stefan Kertesz10,11, Janet M Turan12, Olivio J Clay13, Joanna L Starrels14, Meredith Kilgore12. 1. a Division of Infectious Diseases , University of Alabama at Birmingham , Birmingham , AL , USA. 2. b Division of Gerontology, Geriatrics, and Palliative Care , University of Alabama at Birmingham , Birmingham , AL , USA. 3. c Department of Biostatistics, School of Public Health , University of Alabama at Birmingham , Birmingham , AL , USA. 4. d Department of Medicine , University of California-San Francisco , San Francisco , CA , USA. 5. e Pain Research, Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Healthcare System , West Haven , CT , USA. 6. f Departments of Psychiatry, Neurology and Psychology , Yale University , New Haven , CT , USA. 7. g Veterans Affairs Health Services Research & Development Center for Health Information and Communication , Indianapolis , IN , USA. 8. h Department of Medicine, Division of General Internal Medicine , Indiana University School of Medicine , Indianapolis , IN USA. 9. i Regenstrief Institute , Indianapolis , IN , USA. 10. j Birmingham VA Medical Center , Birmingham , AL , USA. 11. k Division of Preventive Medicine, Department of Medicine , University of Alabama at Birmingham , Birmingham , AL , USA. 12. l Department of Health Care Organization and Policy, School of Public Health , University of Alabama at Birmingham , Birmingham , AL , USA. 13. m Department of Psychology, College of Arts and Sciences , University of Alabama at Birmingham , Birmingham , AL , USA. 14. n Albert Einstein College of Medicine and Montefiore Medical Center , Bronx , NY , USA.
Abstract
BACKGROUND:Chronic pain is a common, disabling, and costly comorbidity, particularly in people living with HIV (PLWH). This study developed and pilot tested a pain self-management intervention for chronic pain tailored to PLWH called Skills TO Manage Pain (STOMP). OBJECTIVES: Given the additional resources needed to deliver STOMP in HIV clinical settings, an important objective of the pilot study was to assess not only STOMP's preliminary efficacy, but also its cost-effectiveness. RESEARCH DESIGN AND SUBJECTS: The present study draws from a 44-participant, 2-arm randomized pilot trial of the STOMP intervention vs usual care among PLWHand at least moderate chronic pain (Clinicaltrials.gov: NCT02824562). Cost-effectiveness is presented as the incremental cost-effectiveness ratio (ICER). Costs were considered from the clinic perspective over a 1-year time horizon using real costs from the pilot trial. It was conservatively assumed there would be no costs savings. The Standard Gamble (SG) method was used to directly measure utilities. RESULTS:Thirty-six participants met inclusion criteria for the present analyses. Mean age was 52 years; 61% were female and 86% were black. The total cost of STOMP was $483.83 per person. Using the SG method, the change in QALYs was 0.15, corresponding to an ICER of $3,225. CONCLUSIONS:STOMP's cost/QALY is substantially lower than the $50,000 to $100,000/QALY benchmark often used to indicate cost-effectiveness. Although based on a pilot trial and, therefore, preliminary, these findings are promising, and suggest the importance of cost analyses in future STOMP trials.
RCT Entities:
BACKGROUND:Chronic pain is a common, disabling, and costly comorbidity, particularly in people living with HIV (PLWH). This study developed and pilot tested a pain self-management intervention for chronic pain tailored to PLWH called Skills TO Manage Pain (STOMP). OBJECTIVES: Given the additional resources needed to deliver STOMP in HIV clinical settings, an important objective of the pilot study was to assess not only STOMP's preliminary efficacy, but also its cost-effectiveness. RESEARCH DESIGN AND SUBJECTS: The present study draws from a 44-participant, 2-arm randomized pilot trial of the STOMP intervention vs usual care among PLWH and at least moderate chronic pain (Clinicaltrials.gov: NCT02824562). Cost-effectiveness is presented as the incremental cost-effectiveness ratio (ICER). Costs were considered from the clinic perspective over a 1-year time horizon using real costs from the pilot trial. It was conservatively assumed there would be no costs savings. The Standard Gamble (SG) method was used to directly measure utilities. RESULTS: Thirty-six participants met inclusion criteria for the present analyses. Mean age was 52 years; 61% were female and 86% were black. The total cost of STOMP was $483.83 per person. Using the SG method, the change in QALYs was 0.15, corresponding to an ICER of $3,225. CONCLUSIONS: STOMP's cost/QALY is substantially lower than the $50,000 to $100,000/QALY benchmark often used to indicate cost-effectiveness. Although based on a pilot trial and, therefore, preliminary, these findings are promising, and suggest the importance of cost analyses in future STOMP trials.
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