The Epidemiology and Economics of Chronic Back Pain

项目摘要。下腰痛在发病率和医疗支出方面造成了很高的负担。 从政策角度来看，有两个重要问题。首先，许多患者最终会出现腰痛 过渡到长期使用阿片类药物，其结果是对死亡率、发病率和医疗支出的影响。 其次，许多治疗下腰痛的方法的成本效益还没有完全确定。这个 该项目的长期目标是(1)描述长期使用阿片类药物的经济学和流行病学特征 在腰痛患者中，(2)评估治疗程序(如硬膜外类固醇)是否 注射)减少阿片类药物的使用和医疗保健支出，以及(3)评估替代方案的成本效益 治疗腰背痛。实现这些目标将使政策制定者和支付者了解 下腰痛的流行病学和经济学，并改善政策制定，例如通过帮助指导 下腰痛治疗的支付政策。对于此特定应用程序，目标是使用 来自Medicare的管理健康声明数据：(1)描述老年患者的阿片类药物使用轨迹 下腰痛以及影响这些轨迹的患者/提供者因素，(2)分析有效性 硬膜外类固醇注射(ESIS)在减少这些患者的阿片类药物使用和医疗费用方面的作用 (3)硬膜外注射类固醇的成本-效果分析。这项研究的创新之处在于它使用了大量 数据库和复杂的统计方法，为所述问题提供明确答案 上面。它之所以意义重大，是因为它采用了全面的方法来解决几项政策--以及 NIDA感兴趣和感兴趣的临床相关问题。除了研究之外， 在实现上述目标的同时，该项目还将使候选人能够实现他成为 卫生经济学/政策方面的独立研究员，特别关注慢性疼痛的经济学。 具体地说，该项目将通过(1)增加应聘者的经验和背景来帮助他的发展 在疼痛研究、成瘾药物和非药物疼痛治疗方面；(2)给予主要的 调查员使用以下工具进行成本效益研究所需的教学培训和经验 决策科学。该项目利用了斯坦福大学的优势，如多学科 指导团队为应聘者的兴趣和背景量身定做。此外，它还利用了 现有的卫生政策博士课程(在决策科学方面有特定的轨道)，以提供教学 应聘者需要培训和实践经验，以便学习决策科学并过渡到 独立调查员的职业生涯。有了这种培训和经验，应聘者将是独一无二的 能够使用他之前经济学背景的工具，以及决策科学的工具 寻求进一步的资金，以评估其他治疗的有效性-以及总体政策-在 减少阿片类药物的使用，治疗慢性疼痛。

Project Summary. Low back pain imposes a high burden in terms of morbidity and healthcare spending. From a policy standpoint, there are two important issues. First, many patients with low back pain ultimately transition into chronic opioid use, with its resulting effects on mortality, morbidity, and healthcare spending. Second, the cost-effectiveness of many treatments for low back pain has not been fully characterized. The long-term goal of this project are to (1) characterize the economics and epidemiology of chronic opioid use among patients with low back pain, (2) evaluate whether therapeutic procedures (such as epidural steroid injections) reduce opioid use and healthcare spending, and (3) evaluate the cost-effectiveness of alternative treatments for low back pain. Accomplishing these goals will inform policymakers and payers about the epidemiology and economics of low back pain, and improve policymaking, for example by helping to guide payment policies for low back pain treatments. For this particular application, the objectives are to use administrative health claims data from Medicare to: (1) characterize opioid use trajectories in elderly patients with low back pain as well as patient/provider factors that affect these trajectories, (2) analyze the effectiveness of Epidural Steroid Injections (ESIs) in reducing opioid use and healthcare spending among these patients and (3) analyze the cost-effectiveness of Epidural Steroid Injections. This research is innovative in its use of large databases and sophisticated statistical approaches to provide definitive answers to the questions described above. It is significant because of its comprehensive approach towards addressing several policy- and clinically-relevant questions of compelling interest and of interest to the NIDA. In addition to the research objectives outlined above, this project will also allow the candidate to achieve his long-term goal of becoming an independent investigator in health economics/policy with a particular focus on the economics of chronic pain. Specifically, the project will aid the candidate’s development by (1) increasing his experience and background in pain research, addiction medicine, and non-pharmacologic pain treatments and (2) giving the primary investigator the didactic training and experience needed to perform cost-effectiveness studies using tools from decision science. The project leverage the strengths of Stanford University, such as a multidisciplinary mentoring team uniquely tailored to the candidate’s interests and background. In addition, it takes advantage of an existing PhD program in Health Policy (with a specific track in decision science) to provide the didactic training and practical experience the candidate requires in order to learn decision science and transition into a career as an independent investigator. With this training and experience, the candidate will be uniquely positioned to use tools from his prior background in economics, as well as the tools of decision science, to seek further funding that will evaluate the effectiveness of other treatments—as well as policies in general--in reducing opioid use and treating chronic pain.