Pain severity and the economic burden of neuropathic pain in the United States: BEAT Neuropathic Pain Observational Study

Abstract

BackgroundAs with many chronic conditions, patients with neuropathic pain (NeP) are high consumers of health care resources. However, limited literature exists on the economic burden of NeP, including its impact on productivity. The aim of this study was to characterize health care resource utilization, productivity, and costs associated with NeP by pain severity level in US adults.MethodsSubjects (n=624) with painful diabetic peripheral neuropathy, human immunodeficiency virus-related peripheral NeP, post-trauma/post-surgical NeP, spinal cord injury with NeP, chronic low back pain with NeP, and small fiber neuropathy were recruited during routine office visits to US community-based general practitioners and specialists. Clinicians captured clinical characteristics, NeP-related medications, and health care resource utilization based on 6-month retrospective medical chart review. Subjects completed questionnaires on demographics, pain/symptoms, costs, and productivity. Brief Pain Inventory pain severity scores were used to classify subjects by mild, moderate, or severe pain. Annualized NeP-related costs (adjusted for covariates) were estimated, and differences across pain severity groups were evaluated.ResultsIn total, 624 subjects were recruited (mean age 55.5±13.7 years; 55.4% male), and 504/624 (80.8%) reported moderate or severe pain. Statistically significant differences were observed across pain severity levels for number of comorbidities, prescription medications, physician office visits, and lost productivity (all P≤0.0001). At all pain severity levels, indirect costs were the primary cost driver. After adjusting for demographic and clinical variables, total mean (95% confidence interval [CI]) annualized direct medical costs to payers, direct costs to subjects, and indirect costs per subject were US$6,016 (95% CI 5,316–6,716), US$2,219 (95% CI 1,919–2,519), and US$19,000 (95% CI 17,197–20,802), respectively, with significant differences across pain severity levels.ConclusionSubjects with NeP, mainly those showing moderate or severe pain, had significant associations between pain severity and NeP-related health care resource utilization, productivity, and costs. The economic burden, particularly indirect costs, was highest among those with severe pain and higher than previously reported in studies of specific NeP conditions.

Cost of treatment of peripheral neuropathic pain with pregabalin or gabapentin in routine clinical practice: impact of their loss of exclusivity

“…Similarly, Chevalier et al ,35 in a modeling study, concluded that from the perspective of the payer in Belgium pregabalin offers a slight increase in quality of life in the populations studied in comparison with standard care. Other studies have corroborated the reduction of work‐related costs in patients treated with pregabalin 36. These findings are consistent with ours.…”

“…It is one of the series with the highest number of subjects studied, which should be interpreted as a study strength 31, 32, 33, 34, 35, 36. However, it should be noted that without appropriate standardization of patient characteristics, as well as in the number and extent of the variables studied, the results obtained should be interpreted with caution, and care should be taken in the external validation of the results.…”

The prevalence and impact of chronic neuropathic pain on daily and social life: A nationwide study in a Japanese population

“…Despite spending more on healthcare resources, this study showed that participants with NeP did not experience better outcomes or satisfaction than those without NeP. Similarly, Schaefer et al (2014) reported that participants with greater NeP severity use more healthcare resources in terms of both direct and indirect costs. They estimated that the adjusted total mean annualized direct cost to payers was $27,259 per participant based on 624 established patients with NeP.…”

Depression as a mediator of quality of life in patients with neuropathic pain: A cross‐sectional study

“…chronic pain, depression, mediation effect, neuropathic pain, nurse, nursing, pain, pain nursing practice, quality of life Kong, patients with NeP had more severe pain intensity, more pain descriptors, worse sleep quality and more lost workdays than those chronic pain patients without NeP (Inoue et al, 2017;Wong, Choi, & Cheung, 2018). In Europe and America, poor QoL in patients with NeP constitutes a heavy illness burden for patients and their caregivers or family members (Liedgens, Obradovic, De Courcy, Holbrook, & Jakubanis, 2016;Schaefer et al, 2014). As a result, improving QoL of patients with NeP is an important issue in nursing practice.…”