DEEP Study: Predictors of Cost and Quality-of-life in Persistent Pain

Objectives: Over time persistent orofacial pain (POFP) requires use of healthcare and has on-going impacts on quality-of-life (QOL), but the clinical predictors of healthcare costs and QOL are unknown. The objective of this study was to examine if dichotomised graded chronic pain status (dGCPS) is predictive of the cost of healthcare and QOL over an eighteen-month period and therefore may be a useful screening instrument to help determine stratified care pathways for patients presenting with POFP.
Methods: Data on healthcare use, QOL (EQ-5D-5L) and multidimensional pain (West Haven-Yale Multidimensional pain inventory; Graded chronic pain scale dichotomised to dGCPS: high [IV-IIb]; low [IIa-0]) were collected from a POFP patient cohort at three, six-monthly, time points: M0 n=201; M6 n=173; M12 n=156. English national reference costs or study-specific estimates were the unit costs of the healthcare used. A generalised linear model was used to examine the relationship between healthcare costs of POFP and its predictors, using unbalanced panel data from the three time points. A random effect panel data model was used to investigate the predictors of QOL.
Results: Mean six-monthly total healthcare cost over the eighteen-month period was £532 (95%CI £464; £601), with consultation costs accounting for a significant proportion (p<0.0001) of this cost. After controlling for sociodemographic factors, dGCPS status was shown to be a significant predictor of healthcare cost over the eighteen-month period accounting for a £178 increase in cost of care from low to high dGCPS (95%CI £37; £317, p<0.01). dGCPS was also a significant predictor of QOL accounting for a decrease in QOL as measured by utility of -0.053 (95%CI -0.087; -0.019, p<0.01).
Conclusions: As a simple stratification, dGCPS has the potential to help determine a stratified model of healthcare for patients on first presentation allowing different treatment care pathways and regimens to be prescribed by dGCPS.