Assessment of the efficiency of the clinical management of neuropathic pain in specialist clinics compared to general clinics in neurology health care Units in Spain

Abstract

Objectives To analyse the cost-consequences of chronic neuropathic pain (NP) outpatient care comparing management in general clinics (GC) versus specialised pain clinics (SPC) in neurology settings in Spain. Methods A 6-month retrospective, cross-sectional, comparative observational study including NeP subjects was designed. Sociodemographics and clinical characteristics of subjects along with pain-related healthcare and non-healthcare resource utilisation were recorded. Lost-work-days equivalent missed as a consequence of pain were also collected to compute indirect costs. Costs to society were calculated in euros for the year 2008. Severity and interference of pain were used for the main effectiveness evaluation. Results A total of 234 patients (53% in SPC), 56.8% women, aged 59.3±14.7 years, were included. Patients were allocated according to usual administrative procedures in each participant centre, consecutively and independently of the diagnosis and clinical status of patients. Yearly indirect costs were €1,299±2,804 in SPC compared to €1,483±3,452 in GC (p=0.660), while annual direct costs were, €2,911±3,335 and €3,563±4,797, respectively (p=0.239), with total costs of €4,210±4,654 and €5,060±6,250, respectively (p=0.249). Mean pain severity at the time of evaluation was 3.8±2.3 in subjects in SPC vs. 5.2±2 in GC (p<0.001), while the mean interference of pain on daily activities was 3.3±2 and 4.7±2.5, respectively (p<0.001). Conclusions In neurology settings in Spain, the outpatient clinical management of chronic NP in SPC is a dominant alternative compared with GC healthcare, since it has shown better patient healthcare outcomes with less severity and interference of pain on daily activities, while maintaining a similar level of costs. These results could help health decision makers when planning the use of healthcare resources.