Background & Aims

Fibromyalgia is one of the largest health burdens in countries around the globe. Pain specialists had developed a multimodal and interdisciplinary approach to chronic pain management in the 1980ies that leads to major improvements in functioning and quality of life and reduced work absenteeism. Structured interdisciplinary pain management is offered by specialized clinics in some countries, but is not generally available to the patient population at large. This is partly due to the consideration that it may be too expensive. Led by the European Brain Council within the Value of Treatment (VoT) initiative, VoT Chronic Pain analysed to what extent the cost of structured interdisciplinary management is offset by savings in direct and indirect cost of continuing the current standard of care.
The aim of this study is to assess the cost-effectiveness of chronic pain management in Germany with and without structured interdisciplinary treatment in patients with fibromyalgia.

Methods

This cost-effectiveness analysis (CEA) is performed for a cohort of patients entering Step 3 of pain management of fibromyalgia. Data sources used include clinical trials, other published literature, and specific German epidemiology and costing data, and clinical expert opinion. The model includes relevant economic measures such as resource utilization patterns associated with outpatient and inpatient care for the treatment of fibromyalgia. This analysis is conducted according to the country-specific guidelines for economic evaluations and budget impact analyses. This CEA is based on a 5-year time horizon with discount rate of 3% for clinical and economic outcomes.
A Markov model is constructed for chronic pain management in Germany for fibromyalgia. pain. The Markov health states are corresponding with Steps 3 to 5 in a pain management flowchart including an absorption state for refractory patients.

Results

Using Germany as a model country, standard of care was estimated to yield 3.30 QALYs over 5 years at a cost of € 3,836 per patient. Structured interdisciplinary management was estimated to yield 3.56 QALYs at € 3,718 cost. Thus a broader availability of structured interdisciplinary management and self-management is predicted to yield an improvement by 0.26 QALY with a saving of € 118 per patient. Extensive sensitivity analyses and scenario analyses confirmed that the base case cost-effectiveness estimate was robust. One-way sensitivity analyses showed that the model was most sensitive to proportion of patients switching to structured interdisciplinary pain management.

Conclusions

In terms of health economic modelling, pain management with structured interdisciplinary approach based on a shared bio-psycho-social model can be called a “dominant strategy” compared to conventional pain management as it leads to both cost savings and QALY gain in patients with fibromyalgia. Therefore, the inclusion of structured interdisciplinary treatment is cost-effective for German society. Hence, European guidelines should recommend this approach as first line treatment for fibromyalgia, for the benefit of both the people affected and the German economy at large.

References

Bidonde J, Fisher E, Perrot S, Moore RA, Bell RF, Makri S, Häuser W (2023) Effectiveness of non-pharmacological interventions for fibromyalgia and quality of review methods: an overview of Cochrane Reviews. . Semin Arthritis Rheum. 2023 Dec;63:152248. doi: 10.1016/j.semarthrit.2023.152248. Epub 2023 Aug 11. PMID: 37598586

Deutsche Schmerzgesellschaft. Definition, Pathophysiologie, Diagnostik und Therapie des Fibromyalgiesyndroms. Available from: https://www.awmf.org/leitlinien/detail/ll/145-004.html [cited: tt.mm.jjjj]

Presenting Author

Mark Nuijten

Poster Authors

mark nuijten

MD, PhD.

a2m

Lead Author

E-mail

Frank PETZKE

Prof. Dr

Department of Anesthesiology, University Hospital Medical Center, Gottingen, Germany

Lead Author

E-mail

Geert dom prof. dr.

Antwerp University, Belgium

Lead Author

E-mail

elena ENAX-KRUMOVA

Prof Dr,

University Hospital Bergmannsheil Bochum, Germany

Lead Author

E-mail

Dieyenaba FAYE

European Brain Council

Lead Author

E-mail

Winfried HÄUSER

Prof. Dr.

Psychosomatic Medicine and Psychotherapy, Technical University of Munich

Lead Author

E-mail

Levent Ertu?rul INAN

Prof. Dr

Health Sciences University, Ankara SUAM, Turkey

Lead Author

E-mail

Ulrike KAISER

PhD Dr

University Hospital Schleswig-Holstein, Clinic for Anesthesiology / Intensive Care Medicine, Lübeck

Lead Author

E-mail

Serge PERROT

MD

Centre de la Douleur, Hôpital Cochin, Université de Paris

Lead Author

E-mail

Gudula PETERSEN

Dr

Grunenthal, Germany

Lead Author

E-mail

Martin RAKUSA

Prof. Dr.

University Medical Center Maribor, Slovenia

Lead Author

E-mail

Deirdre RYAN

Pain Alliance Europe

Lead Author

E-mail

Andrea Truini

University Sapienza

Lead Author

E-mail

Rolf-Detlef Treede

Heidelberg University

Lead Author

E-mail

Topics

  • Other