Eliciting health state utilities from the general public for severe chronic pain.
OBJECTIVE
There is an absence of data on public preferences for health states (HSs) associated with severe chronic pain. The aim of this study was to develop accurate HS descriptions for severe chronic pain requiring intrathecal (IT) therapy and to derive utility weights that describe the health-related quality of life (HRQL) impact of chronic pain associated with malignant (MP) and non-malignant (NMP) aetiologies.


METHODS
Eight visual analogue scale pain index (VAS-PI) HSs were defined using ranges 0-40, 41-60, 61-80 and 81-100 applied to both MP and NMP. Additionally, eight HSs representing common adverse events associated with IT therapy were identified. The content and description of the HSs were ascertained by interviews with five United Kingdom clinical experts. In total, 16 HSs were compiled. These HS descriptions and HS questionnaires were administered to 102 members of the public, utilising a time trade off (TTO) approach to estimate utilities for the HSs.


RESULTS
Participants generally were well matched to the general public in England and Wales, with some differences in mean age, race and education. A substantial decline in utility was observed with more severe VAS-PI values. The mean TTO utility values also decreased from mild pain to severe pain. Participants were able to differentiate between the side effects.


CONCLUSIONS
The study shows a clear decrement in utility moving from different severity levels of severe chronic pain.
Eldabe
S
S
Department of Pain and Anaesthesia, The James Cook University Hospital, Middlesbrough, UK.
Lloyd
A
A
Verdian
L
L
Meguro
M
M
Maclaine
G
G
Dewilde
S
S
D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D004739:England; D005260:Female; D006304:Health Status; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D010146:Pain / Q000191:economics* / Q000209:etiology / Q000503:physiopathology; D010147:Pain Measurement; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D014852:Wales
D000701:Analgesics, Opioid
Anesth Analg. 2008 Feb;106(2):628-37, table of contents
18227325
J Pain Symptom Manage. 2003 Jul;26(1):668-77
12850649
Reg Anesth Pain Med. 2000 May-Jun;25(3):274-8
10834782
South Med J. 1996 Mar;89(3):295-300
8604459
Spine (Phila Pa 1976). 1983 Mar;8(2):141-4
6222486
Pain. 2002 Sep;99(1-2):299-307
12237208
Anesthesiology. 1994 Feb;80(2):284-97
8311311
Neurosurgery. 1999 Feb;44(2):289-300; discussion 300-1
9932882
Health Policy. 1990 Dec;16(3):199-208
10109801
Pharmacotherapy. 2006 Mar;26(3):395-402
16503720
Med Care. 1997 Nov;35(11):1095-108
9366889
Clin J Pain. 1997 Sep;13(3):256-9
9303259
Acad Radiol. 2005 Apr;12(4):467-74
15831420
Support Care Cancer. 1998 Nov;6(6):495-502
9833297
Eur J Pain. 2006 May;10(4):287-333
16095934
Pain. 1983 Sep;17(1):45-56
6226917
JAMA. 2004 Jan 7;291(1):63-70
14709577
J Clin Pharmacol. 2003 Jun;43(6):624-36
12817525
J Pain Symptom Manage. 2006 May;31(5):393-406
16716870
Pain. 1983 May;16(1):87-101
6602967
Fam Pract. 2001 Jun;18(3):292-9
11356737
Spine (Phila Pa 1976). 1983 Mar;8(2):145-50
6222487
Neuromodulation. 1999 Apr;2(2):92-107
22151113
J Health Econ. 2002 Mar;21(2):271-92
11939242
Neuromodulation. 2001 Jul;4(3):111-5
22151655
JAMA. 1998 Jul 8;280(2):147-51
9669787
Can J Anaesth. 1996 Apr;43(4):379-83
8697554
J Neurosurg. 1996 Sep;85(3):458-67
8751633
Clin J Pain. 1998 Mar;14(1):17-28
9535310
Health Technol Assess. 2000;4(32):iii-iv, 1-65
11173307
Clin J Pain. 2007 Feb;23(2):180-95
17237668
Eur J Pain. 2006 Feb;10(2):127-35
16310716