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Systematic review of costs and effects of self-management interventions for chronic musculoskeletal pain: spotlight on analytic perspective and outcomes assessment |
Hernon MJ, Hall AM, O'Mahony JF, Normand C, Hurley DA |
Physical Therapy 2017 Oct;97(10):998-1019 |
systematic review |
BACKGROUND: Evidence for the cost-effectiveness of self-management interventions for chronic musculoskeletal pain (CMP) lacks consensus, which may be due to variability in the costing methods employed. PURPOSE: The purposes of the study were to identify how costs and effects have been assessed in economic analysis of self-management interventions for CMP and to identify the effect of the chosen analytical perspective on cost-effectiveness conclusions. DATA SOURCES: Five databases were searched for all study designs using relevant terms. STUDY SELECTION: Two independent researchers reviewed all titles for predefined inclusion criteria: adults (>= 18 years of age) with CMP, interventions with a primary aim of promoting self-management, and conducted a cost analysis. DATA EXTRACTION: Descriptive data including population, self-management intervention, analytical perspective, and costs and effects measured were collected by one reviewer and checked for accuracy by a second reviewer. DATA SYNTHESIS: Fifty-seven studies were identified: 65% (n = 37) chose the societal perspective, of which 89% (n = 33) captured health care utilization, 92% (n = 34) reported labor productivity, 65% (n = 24) included intervention delivery, and 59% (n = 22) captured patient/family costs. Types of costs varied in all studies. Eight studies conducted analyses from both health service and societal perspectives; cost-effectiveness estimates varied with perspective chosen, but in no case was the difference sufficient to change overall policy recommendations. LIMITATIONS: Chronic musculoskeletal pain conditions where self-management is recommended, but not as a primary treatment, were excluded. Gray literature was excluded. CONCLUSION: Substantial heterogeneity in the cost components captured in the assessment of self-management for CMP was found; this was independent of the analytic perspective used. Greater efforts to ensure complete and consistent costings are required if reliable cost-effectiveness evidence of self-management interventions is to be generated and to inform the most appropriate perspective for economic analyses in this field.
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