Study Assesses Cost and Benefit of Collaborative Care Intervention for Veterans with Chronic Pain and Depression
Chronic, non-cancer pain is associated with considerable physical and psychosocial impairment, and increased healthcare use and costs. Collaborative care interventions based in primary care have emerged as one successful approach to supporting guideline-concordant care and improving outcomes for chronic conditions. The "Study of the Effectiveness of a Collaborative Approach to Pain" (SEACAP) sought to assess whether a novel collaborative care intervention would result in improvements in chronic pain and depression outcomes compared with treatment as usual (TAU) among patients treated in a VA primary care setting. This study reports on the incremental benefit (pain disability-free days) and incremental health services costs of the SEACAP intervention from a VA healthcare perspective. Investigators examined VA data for 187 Veterans in the intervention group and 214 Veterans in the TAU group, focusing on two primary outcome measures: pain disability-free days (PDFDs) and treatment costs.
Findings show that the collaborative care intervention resulted in more pain-free days for Veterans with chronic pain and depression, but was more expensive than usual care. Veterans in the intervention group experienced an average of 16 additional PDFDs over the 12 month follow-up period compared to Veterans in the TAU group, with a cost per PDFD of $364 (overall, about $2300 per patient during the study year). Study results also show that important predictors of costs were baseline medical comorbidities, depression severity, and prior year's treatment costs. The authors recommend further research to ascertain whether or not the intervention is more cost-effective for some patient subgroups - and to learn whether pain improvements and higher costs persist after the intervention has ended.
Dickinson K, Sharma R, Duckart J, Corson K, Gerrity M, and Dobscha S. VA Healthcare Costs of a Collaborative Intervention for Chronic Pain in Primary Care. Medical Care January 2010;48(1):38-44.
This study was funded by HSR&D. All authors are part of HSR&D's Center for the Study of Chronic, Comorbid Mental and Physical Disorders in Portland, OR.