HEALTH UTILITIES IN ADULTS WITH CHRONIC PAIN
Monday, October 19, 2015
Grand Ballroom EH (Hyatt Regency St. Louis at the Arch)
Almost 1 in 5 adults has chronic pain. New
interventions are being developed to manage this widespread condition and
cost-utility analyses of these technologies require robust data. We aimed to
estimate utilities using a population based sample of adults with chronic pain
and examine the contribution of several factors.
Health Utilities Index Mark 3 (HUI3) values, self-reported
race/ethnicity and presence of arthritis, back problems, migraines, heart
disease, stroke, diabetes and cancer were obtained from the Ontario survey
responses of the Canadian Community Health Survey (CCHS) 2009-10. The CCHS
questions for presence of pain, severity and disability from pain were used to identify
and stratify patients with chronic pain. Income, aggregated diagnosis groups (ADGs,
Johns Hopkins ACG system, a measure of comorbidity), age and sex were obtained
from linked administrative data. Ordinary least squares regression was used to
investigate the impact of variables on utility.
A total of 15,901 responses for adults 18 – 64 years of
age were available for analysis and 4,116 reported chronic pain. In the pain
cohort, mean age was 48 years (SD 12); 59% were female. The average number of
ADGs was 4.2 (SD 2.9). People with chronic pain had a mean utility of 0.60,
0.22 points below the overall sample mean (see table). Increasing income
quintile was associated with an increase in utility (p<0.001) as was black
race (p < 0.05) (versus Caucasian). Aboriginal ethnicity was
associated with a decrease in utility (p<0.001). Presence of the following
conditions was associated with a decrease in utility: migraine, back problems,
arthritis, suffering from the effects of a stroke, heart disease, diabetes and an
additional ADG (all p<0.001). Age, sex, and having cancer were not
significantly associated with utility change.
Utilities in people with chronic pain were very low and decreased
with greater pain and more activity limitations. A decrement of 0.22 is larger
than seen with heart disease, diabetes, COPD, asthma and epilepsy.1 To
our knowledge, this study is the first to estimate utilities in patients with
chronic pain at the population level. This data will be useful to inform
future cost-utility analyses.
1Mittmann N, Trakas K, Risebrough N, Liu B.
Utility scores for chronic conditions in a community-dwelling population.
Pharmacoeconomics 1999; 15(4):369-376.