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Cost-effectiveness of a chronic pain intervention for people living with HIV (PLWH).

Cost-effectiveness of a chronic pain intervention for people living with HIV (PLWH).
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Merlin JS, Westfall AO, Johnson MO, Kerns RD, Bair MJ, Kertesz S, Turan JM, Clay OJ, Starrels JL, Kilgore M,


Merlin JS, Westfall AO, Johnson MO, Kerns RD, Bair MJ, Kertesz S, Turan JM, Clay OJ, Starrels JL, Kilgore M, (click to view)

Merlin JS, Westfall AO, Johnson MO, Kerns RD, Bair MJ, Kertesz S, Turan JM, Clay OJ, Starrels JL, Kilgore M,

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Journal of medical economics 2017 09 07() 1-11 doi 10.1080/13696998.2017.1377719

Abstract
BACKGROUND
Chronic pain is a common, disabling, and costly comorbidity, particularly in people living with HIV (PLWH). We 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 versus 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 one-year time horizon using real costs from the pilot trial. We conservatively assumed 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, our findings are promising and suggest the importance of cost analyses in future STOMP trials.

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