The Cost Effectiveness of Complementary and Alternative Treatments to Reduce Pain

描述（由申请人提供）：拟议研究的目标是检查补充和替代医学（CAM）在减少OEF/OIF/OND战争退伍军人中肌肉骨骼（MSD）相关疼痛和MSD疼痛合并症方面的成本效益。具体目标是：（1）确定CAM使用的程度;（2）确定CAM使用的成本;（3）确定与单独常规护理相比，连续使用CAM的成本效益，以及CAM使用对疼痛和疼痛共病状况的医疗保健成本影响;以及（4）获得关于CAM使用的反馈，CAM成本和研究结果，以更好地促进这些结果整合到VA交付CAM的建议，使用关键VA利益相关者的咨询委员会。研究方法：这项研究将利用现有的VA MSD队列数据集，这是一组关于医疗保健使用和成本以及患者和设施特征的综合数据，以及最近上传到VA集中数据分析平台（芬奇）的个人CAM笔记。我们将使用自然语言处理（NLP）数据挖掘方法从叙述性病历记录中提取CAM使用数据，根据VA的医疗分析和信息组（HAIG）报告，重点关注用于MSD疼痛的十大CAM模式。我们将使用VA MSD队列数据中使用的一组预先指定的ICD-9代码对VA MSD疼痛人群进行评估。我们将使用双重稳健估计方法比较使用CAM的患者与未使用CAM的匹配对照组的MSD疼痛。我们还将研究十种不同类型的CAM数量的影响。此外，我们将研究CAM使用对疼痛合并症的影响，如创伤性脑损伤（TBI）和精神健康状况（PTSD，物质滥用障碍，睡眠障碍，焦虑和抑郁）。为了解决结果中的任何大的变化，并使生成的答案的信心，我们将进行敏感性分析。咨询委员会将包括VA在疼痛治疗和政策以及CAM政策和交付方面的国家领导人。意义：慢性MSD疼痛及其合并症的治疗成本很高，并且在OEF/OIF/OND退伍军人中非常普遍。CAM似乎在VA广泛用于疼痛管理。然而，人们对使用何种类型的CAM、提供CAM的成本以及这种CAM的使用是否会导致MSD疼痛患者和MSD疼痛及其精神健康合并症和TBI患者的医疗费用（包括阿片类药物的使用）降低知之甚少。这项成本效益研究的结果将有助于VA确定CAM以及哪些特定类型的CAM是否是在资源有限的情况下减少MSD疼痛及其合并症的有效方法。研究结果也将有助于其他大型医疗机构提供有关如何提供CAM服务的一种模式的成本和影响的信息。创新：这将是第一次广泛研究CAM的使用对VA医疗保健利用和医疗保健成本的整体影响。这也将是首次对患有MSD疼痛的退伍军人进行个人层面CAM使用的多中心检查。

DESCRIPTION (provided by applicant): The goal of the proposed research is to examine the cost effectiveness of complementary and alternative medicine (CAM) in reducing musculoskeletal (MSD)-related pain and MSD-pain comorbidities among Veterans of OEF/OIF/OND wars. The specific aims are to: (1) to determine the extent of CAM use; (2) determine the cost of that CAM use; (3) determine the cost effectiveness of adjunctive CAM use compared to usual care alone as well as the healthcare cost impact of CAM use with both pain and pain-comorbid conditions; and (4) obtain feedback on CAM use, CAM costs and study results to better facilitate the integration of those results into recommendations for VA delivery f CAM, using an advisory board of key VA stakeholders. Methods: This study will capitalize on the existing VA MSD Cohort dataset, a comprehensive set of data on health care use and costs and patient and facility characteristics, and on the recent uploading of individual CAM notes to the VA's centralized data analysis platform (VINCI). We will use natural language processing (NLP) data mining methods to extract CAM use data from narrative medical record notes, focusing on the top ten CAM modalities used for MSD pain according to the VA's Healthcare Analysis & Information Group (HAIG) report. We will the VA MSD pain population using the set of pre-designated ICD-9 codes used in the VA MSD Cohort data. We will compare those who used CAM to matched controls who did not use CAM for their MSD pain using doubly robust estimation methods. We also will examine the impact of the amount of ten different types of CAM. Additionally, we will examine the impact of CAM use on pain comorbidities such as traumatic brain injury (TBI) and mental health conditions (PTSD, substance abuse disorder, sleep disturbance, anxiety, and depression). To address any large variation in results and to enable confidence in the answers generated, we will perform sensitivity analyses. The advisory board will contain the VA's national leaders in pain treatment and policy and CAM policy and delivery. Significance: Chronic MSD pain and its co- morbidities are costly to treat and highly prevalent among OEF/OIF/OND Veterans. CAM appears to be in widespread use for pain management at the VA. However, little is known about what types of CAM are used, the costs of providing CAM, and whether this CAM use results in reductions in healthcare costs (including opioid use) among those with MSD pain and those with MSD pain and its mental health comorbidities and TBI. The results of this cost-effectiveness study will help the VA determine if CAM, and what particular types of CAM, is an efficient way to reduce MSD pain and its co-morbid conditions given limited resources. The results will also be useful to other large healthcare organizations in terms of providing information on the costs and impacts of one model of how CAM services could be delivered. Innovation: This will be the first widespread study of the overall impact of CAM use on healthcare utilization and health care cost at the VA. This also will be the first multi-site examination of individual-level CAM use among Veterans with MSD pain.