title: A health economic model of breakthrough pain.
abstract: Although the literature adequately addresses the biologic basis, epidemiology, and management of breakthrough pain (BTP), it does not yet describe the full impact of this troubling, widespread phenomenon. The risks of a scanty understanding of BTP impact are failure to take preventive measures, underdiagnosis, undertreatment, and inappropriate management. Studies to date of the impact of BTP have followed pharmacoeconomic approaches. Building on prior efforts, this paper develops a more comprehensive health economic model that encompasses the full spectrum of costs, outcomes, risks and benefits associated with BTP and its management. The authors provide a rubric within which stakeholders--including providers, institutional leaders, administrators, and policymakers--can systematically balance the myriad potential effects of different treatment scenarios to guide decision-making. The paper then extends this model to the population level, providing a template for health economic analysis of alternate strategies for managing BTP, and delineating steps for accomplishing the analysis.
authors.affiliation: Center for Palliative Care, Duke University School of Medicine, DUMC 3436, Durham, NC 27710, USA. abern003@mc.duke.edu
authors.forename: Amy P
authors.initials: AP
authors.lastname: Abernethy
authors.forename: Jane L
authors.initials: JL
authors.lastname: Wheeler
authors.forename: Barry V
authors.initials: BV
authors.lastname: Fortner
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000191:economics; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D017850:Economics, Pharmaceutical; D005260:Female; D006801:Humans; D008875:Middle Aged; D018803:Models, Economic; D009101:Multiple Myeloma / Q000150:complications; D010146:Pain / Q000188:drug therapy / Q000191:economics* / Q000209:etiology
chemical_list: D000701:Analgesics, Opioid