Abstract
ObjectivesPharmacotherapy may have a limited role in long-term pain management. Comparative trajectories of drug prescriptions and costs, two quality-of-care indicators for pain conditions, are largely unknown subsequent to conventional or integrative care (IC) management. The objectives of this study were to compare prescribed defined daily doses (DDD) and cost of first line drugs for pain patients referred to conventional or anthroposophic IC in Stockholm County, Sweden.MethodsIn this retrospective high quality registry case-control study, IC and conventional care patients were identified through inpatient care registries and matched on pain diagnosis (ICD-10: M79), age, gender and socio-demographics. National drug registry data was used to investigate changes in DDD and costs from 90/180 days before, to 90/180 days after, index visits to IC and conventional care. The primary selected drug category was analgesics, complemented by musculo-skeletal system drugs (e.g. anti-inflammatories, muscle relaxants) and psycholeptics (e.g. hypnotics, sedatives).ResultsAfter index care visits, conventional care pain patients (n = 1050) compared to IC patients (n = 213), were prescribed significantly more analgesics. The average (95% CI) group difference was 15.2 (6.0 to 24.3), p = 0.001, DDD/patient after 90 days; and 21.5 (7.4 to 35.6), p = 0.003, DDD/patient after 180 days. The cost of the prescribed and sold analgesics was significantly higher for conventional care after 90 days: euro/patient 10.7 (1.3 to 20.0), p = 0.025. Changes in drug prescription and costs for the other drug categories were not significantly different between groups.ConclusionsDrug prescriptions and costs of analgesics increased following conventional care and decreased following IC, indicating potentially fewer adverse drug events and beneficial societal cost savings with IC.
Highlights
Swedish health bylaws state that every county council is obliged to provide residents with taxpayer-funded high-quality medical care and appropriate health promotion programs
Drug prescriptions After the index visits, the conventional care pain patients were prescribed significantly more analgesics compared to the integrative care (IC) patients (Tables 2 and 3)
The average group difference for analgesics at 90 days post index visit was 15.2 defined daily doses (DDD)/patient
Summary
Swedish health bylaws state that every county council is obliged to provide residents with taxpayer-funded high-quality medical care and appropriate health promotion programs. IC has become a strategic but much debated hallmark of several national and international research and policy agendas [5,6,7]. Therapies such as massage, manual therapy, acupuncture and mindfulness can be found in current national care guidelines for managing persistent and recurrent disorders such as pain and depression [8,9]. It is critical that this development adhere to clinically and cost-effective health care systems. Opponents argue that such developments are neither rational nor effective, and are effectively overburdening the healthcare system. Evidence of the comparative effectiveness of IC and conventional care health care models is urgently needed for evidence informed decision-making, and health technology assessments of IC have been called for [12]
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