title: Health Care Utilization and Cost in Children and Adolescents With Chronic Pain: Analysis of Health Care Claims Data 1 Year Before and After Intensive Interdisciplinary Pain Treatment.
abstract: OBJECTIVE
  The aim of this study was to analyze changes in health care utilization and cost among a sample of highly impaired children and adolescents who sought a 3-week intensive interdisciplinary pain treatment (IIPT).
  
  
  METHODS
  Claims data from 7 statutory health insurance companies were analyzed for 65 children and adolescents who sought IIPT at the German Paediatric Pain Centre. The annual health care utilization and cost were determined for the following 4 areas: outpatient care, inpatient care, medications, and remedies and aids. We analyzed the changes in resource utilization in the year before (pre_1 y) IIPT and in the subsequent year (post_1 y).
  
  
  RESULTS
  Within the first year after IIPT, overall health care costs did not decrease significantly. However, the pattern of health care utilization changed. First, significantly more children and adolescents started outpatient psychotherapy (P=0.001). Second, the number of hospitalized children decreased significantly from 1-year pre to 1-year post (P=0.001). Accordingly, there were significantly fewer hospitalizations for primary chronic pain disorders at 1-year post (P<0.001). The prescription of nonopioids, co-analgesics and opioids was significantly reduced from 1-year pre to 1-year post (all P<0.013).
  
  
  CONCLUSIONS
  The present results indicate that the health care costs of children and adolescents with severe chronic pain disorders do not significantly decrease 1 year after IIPT; however, the treatment becomes more goal-focused. Differential diagnosis measures and nonindicated therapeutic interventions decreased, and more indicated interventions, such as psychotherapy, were used. Future research is needed to investigate the economic long-term changes after IIPT.
authors.affiliation: *German Paediatric Pain Centre, Children's and Adolescents' Hospital, and Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health-School of Medicine ‡Institutional Economics and Health Policy, Witten/Herdecke University, Germany †Scientific Institute of the TK (Techniker Krankenkasse) for Benefit and Efficiency in Health Care, Hamburg, Germany.
authors.forename: Ann-Kristin
authors.initials: AK
authors.lastname: Ruhe
authors.forename: Michael
authors.initials: M
authors.lastname: Frosch
authors.forename: Julia
authors.initials: J
authors.lastname: Wager
authors.forename: Roland
authors.initials: R
authors.lastname: Linder
authors.forename: Ingo
authors.initials: I
authors.lastname: Pfenning
authors.forename: Dirk
authors.initials: D
authors.lastname: Sauerland
authors.forename: Boris
authors.initials: B
authors.lastname: Zernikow
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D000700:Analgesics / Q000191:economics / Q000627:therapeutic use; D002648:Child; D059350:Chronic Pain / Q000191:economics* / Q000628:therapy*; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D059408:Pain Management / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care; D010348:Patient Care Team; D016896:Treatment Outcome
chemical_list: D000700:Analgesics