The burden of neuropathic pain: a systematic review and meta-analysis of health utilities.
Patients with neuropathic pain (NeuP) experience substantially lower health-related quality of life (HRQoL) than the general population. The aim of this systematic review and meta-analysis is to test the hypothesis that NeuP is associated with low levels of health utility. A structured search of electronic databases (MEDLINE, EMBASE, Cochrane Library and CINAHL) was undertaken. Reference lists of retrieved reports were also reviewed. Studies reporting utility single-index measures (preference based) in NeuP were included. Random effects meta-analysis was used to pool EQ-5D index utility estimates across NeuP conditions. The association of utilities and pre-defined factors (NeuP condition, patient age, sex, duration and severity of pain and method of utility scoring) was examined using meta-regression. Twenty-four studies reporting health utility values in patients with NeuP were included in the review. Weighted pooled utility score across the studies varied from a mean of 0.15 for failed back surgery syndrome to 0.61 for post-herpetic neuralgia and diabetic neuropathy. Although there was substantial heterogeneity (P<0.0001) across studies, we found little variation in utility as a function of patient and study characteristics. The single exception was a significant relationship (P<0.0001) between increasing neuropathic pain severity and a reduction in utility. This study confirms the hypothesis that patients with NeuP experience low utilities and therefore low HRQoL. However, the contribution of non-NeuP co-morbidity remains unclear. Neuropathic pain severity emerged as a primary predictor of the negative health impact of NeuP.
Health Policy and Management, University of Minnesota, USA Medtronic Neuromodulation, Minneapolis, USA Department of Molecular Medicine & Surgery, Karolinska Institute, Stockholm, Sweden Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden University of Washington School of Medicine, Seattle, USA Peninsula Medical School, Universities of Exeter & Plymouth, UK.
Alissa H
AH
Doth
Per T
PT
Hansson
Mark P
MP
Jensen
Rod S
RS
Taylor
D000203:Activities of Daily Living / Q000523:psychology; D017281:Cost of Illness; D055111:Failed Back Surgery Syndrome / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D006304:Health Status; D006801:Humans; D051474:Neuralgia, Postherpetic / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D010523:Peripheral Nervous System Diseases / Q000453:epidemiology* / Q000523:psychology* / Q000628:therapy; D011788:Quality of Life / Q000523:psychology*; D012720:Severity of Illness Index