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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

Ruhe, Ann-Kristin MSc PH*; Frosch, Michael MD, PhD*; Wager, Julia PhD*; Linder, Roland PhD; Pfenning, Ingo; Sauerland, Dirk PhD; Zernikow, Boris MD, PhD*

doi: 10.1097/AJP.0000000000000460
Original Articles
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Objectives: 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).

Materials and 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).

Discussion: 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.

*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

The authors declare no conflict of interest.

Reprints: Ann-Kristin Ruhe, MSc PH, German Paediatric Pain Centre, Children’s and Adolescents’ Hospital, Datteln, and Department of Children’s Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health, School of Medicine, Dr.-Friedrich-Steiner-Str.5, 45711 Datteln, Germany (e-mail: a.ruhe@deutsches-kinderschmerzzentrum.de).

Received June 23, 2016

Received in revised form January 5, 2017

Accepted November 12, 2016

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.