Protocol for an economic analysis of the randomised controlled trial of Improving the Well-being of people with Opioid Treated CHronic pain: I-WOTCH Study

Krishnan, Sheeja Manchira; Vijay, Sophia; Sandhu, Harbinder; Underwood, Martin; Eldabe, Sam; Manca, Andrea; Urrutia, Cynthia Paola Iglesias

doi:10.1136/bmjopen-2020-037243

Cited by 3 publications

(3 citation statements)

References 33 publications

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“…This review demonstrates the need for more high-quality research on opioid reduction strategies for patients with CNCP on LTOT. The fact that multiple research protocols for future research in this field were identified while scanning abstract and title [34][35][36][37] can be seen as a step in the right direction. These upcoming studies should build on lessons learned.…”

Section: Implications For Research and Practicementioning

confidence: 99%

Opioid reduction for patients with chronic pain in primary care: systematic review

et al. 2022

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Background: Long-term opioid treatment in patients with chronic pain is often ineffective and possibly harmful. These patients are often managed by general practitioners, who are calling for a clear overview of effective opioid reduction strategies for primary care. Aim: Evaluate effectiveness of opioid reduction strategies applicable in primary care for patients with chronic pain on long-term opioid treatment. Design: Systematic review of controlled trials and cohort studies. Method Literature search conducted in Embase, Medline, Web of Science, Cochrane CENTRAL register of trials, CINAHL, Google Scholar and PsychInfo. Studies evaluating opioid reduction interventions applicable in primary care among adults with long-term opioid treatment for chronic non-cancer pain were included. Risk of bias was assessed using Cochrane risk of bias (RoB) 2.0 tool or Risk-of-Bias in Non-randomized studies of Interventions (ROBINS-I) tool. Narrative synthesis was performed due to clinical heterogeneity in study designs and types of interventions. Results: Five RCTs and five cohort studies were included (total n= 1717, range 35-985) exploring various opioid reduction strategies. Six studies had high RoB, three moderate RoB, and one low RoB. Three cohort studies investigating a GP supervised opioid taper (critical ROBINS-I), an integrative pain treatment (moderate ROBINS-I) and group medical visits (critical ROBINS-I) demonstrated significant between-group opioid reduction. Conclusion: Results carefully point in the direction of a GP supervised tapering and multidisciplinary group therapeutic sessions to reduce long term opioid treatment. However, due to high risk of bias and small sample sizes, no firm conclusions can be made demonstrating need for more high-quality research.

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Section: Implications For Research and Practicementioning

confidence: 99%

Opioid reduction for patients with chronic pain in primary care: systematic review

et al. 2022

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“…To explore the decision uncertainty associated with the cost-effectiveness of iFraP to enhance bisphosphonate adherence we will conduct a VoI analysis. An electronic search of trial-based economic evaluation of digital health interventions study protocols identified only three study protocols and neither of these included a trial based VoI analysis [42][43][44] . No VoI analysis was found when searching the published literature for protocols of cost-effectiveness analyses of digital support tools.…”

Section: Strengthsmentioning

confidence: 99%

Protocol for a trial-based economic evaluation analysis of a complex digital health intervention including a computerised decision support tool: the iFraP intervention

Siciliano,

Bathers,

Bentley

et al. 2024

NIHR Open Res

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Background Digital health interventions (DHI) are associated with significant promise. In recent years, the need to assess the value of these healthcare technologies has motivated a debate regarding the suitability of existing economic evaluation methods in the context of DHI evaluation. Some have argued that robust economic evaluation methods may not be capable of capturing relevant DHI’s characteristics. Others consider that assessing the value of DHI might not be feasible. This protocol paper challenges that view. More specifically, it describes early Health Technology Assessments (HTA) methods to rigorously assess the value for money of a complex intervention including a digital decision support tool i.e., Improving uptake of Fracture Prevention drug treatments (iFraP) as a tracer intervention. iFraP is a complex intervention consisting of a computerised decision support tool, a clinician training package, and information resources to facilitate shared decision-making, increase informed medicine initiation and reduce levels of medicine discontinuation. iFraP’s development was motivated by a view that good quality shared decision-making conversations have the potential to improve levels of osteoporosis medicine uptake. Methods An early economic evaluation of the iFraP intervention was designed to identify, measure, and evaluate the costs and health benefits of iFraP compared to usual practice in Fracture Liaison Services (FLSs). A within-trial cost-effectiveness from the perspective of the National Health Service and Personal Social Service in England will be conducted using patient’s self-reported health related quality of life (HRQoL) and resource use from the iFraP randomised controlled trial. Microanalysis will be used to estimate iFraP’s intervention cost. Finally, Bayesian Value of Information analysis will allow us to estimate an upper bound for the potential health benefits gained from reducing uncertainty on the impact of the iFraP intervention to support uptake and adherence with osteoporosis medicines. Trial registration ISRCTN10606407 - https://doi.org/10.1186/ISRCTN10606407

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“…The impact of ineffective communication during transitions of care (TOCs) on these outcomes was not assessed by these studies. There are ongoing clinical trials on economic impact and clinical outcomes of focused TOC interventions for patients with chronic pain to address this gap in the literature 25,26 . To fill the current void in standards, the Island Peer Review Organization (IPRO) Pain Management Coalition undertook an initiative to generate a consensus list of requisite communication elements (RCEs) that experts agree should be communicated between care settings during TOCs for all patients utilizing opioid analgesics.…”

mentioning

confidence: 99%

Pain management‐related assessment and communication across the care continuum: Consensus of the opioid task force of the island peer review organization pain management coalition

Juba

Triller

Myrka

et al. 2021

J Am Coll Clin Pharm

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Prescription opioid analgesics contribute to serious, preventable adverse drug events (ADEs) and despite efforts ranging from regulatory changes to quality improvement initiatives, national studies indicate that opioid‐related emergency department visits and hospitalizations are increasing amid the coronavirus disease 2019 (COVID‐19) pandemic. Effective pain management is challenging during care transitions, and system imperfections make patients vulnerable to ADEs as they leave one care setting and move to another. Therefore, the Island Peer Review Organization (IPRO) pain management coalition convened a task force to develop resources to guide improvements in opioid‐related communication during patient care transitions. Create a consensus list of requisite communication elements (RCEs) that should accompany all patients prescribed opioids as they undergo care transitions. An interprofessional task force of pain management experts was convened and completed a blinded, iterative Delphi process. After four Delphi rounds, the panel reached consensus on a pain management discharge communication (PMDC) List of 24 RCEs across the domains of opioid dosing and pain management (nine elements), factors associated with adverse drug events (nine elements), and patient education and caregiver support (six elements). During transitions of care providers need detailed information on opioid dosing, pain characteristics, risk factors for adverse events, and patient/caregiver capacity to adequately manage symptoms while avoiding potentially fatal ADEs. The PMDC list may guide the development of new clinical tools, quality measures, accreditation standards, and checklists for pharmacists involved in the delivery of opioid stewardship during a care transition. Additional work is needed to design comprehensive, interprofessional opioid stewardship programs to ensure that the requisite communication elements are consistently available at the time of a care transition.

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Protocol for an economic analysis of the randomised controlled trial of Improving the Well-being of people with Opioid Treated CHronic pain: I-WOTCH Study

Cited by 3 publications

References 33 publications

Opioid reduction for patients with chronic pain in primary care: systematic review

Opioid reduction for patients with chronic pain in primary care: systematic review

Protocol for a trial-based economic evaluation analysis of a complex digital health intervention including a computerised decision support tool: the iFraP intervention

Pain management‐related assessment and communication across the care continuum: Consensus of the opioid task force of the island peer review organization pain management coalition

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