The economics of chronic pain and the stated preference valuation of chronic pain disorders

Objectives. The objectives of this thesis was to: (1) review the literature to examine economic evaluations and willingness to pay studies in chronic pain, (2) determine the association between modifiable health influencing activities and change in health status over one year in persons with chronic migraine, (3) measure the willingness to pay (WTP) for improvements in pain related morbidity (PRM) in persons with chronic pain.;Methods. For the first objective, drawing on available evidence that have appeared in the medical and economic literature, economic evaluations and WTP in chronic pain were searched on selected databases from 2002-2006. For the second objective, a linear regression analysis was applied to the Canadian Community Health Survey Cycle 1.1. The dependent variable was reported health status change over time. Explanatory variables consisted of a series of health care utilization, health behaviour, and background control variables. For the third objective, a discrete choice experiment was administered to measure WTP in 178 respondents attending the University of Alberta Multidisciplinary Pain Centre.;Results. For the first objective, there were 3,935 studies identified. Sixteen studies met the inclusion/exclusion criteria and were included in the review. For the second objective, health status was positively associated with higher levels of physical activity and negatively associated with smoking for both migraineurs and non-migraineurs even when controlling for all other variables. For the third objective, persons with chronic pain are willing to pay ;Conclusions. For the first objective, the majority of economic evaluations in chronic pain were in back pain and there was a wide variability in the economic quality of the studies. WTP also seems to be a viable approach for assessing patient preferences for chronic pain treatments. For the second objective, modifying controllable resources and behaviours can improve the health status of migraineurs as effectively as non-migraineurs. For the third objective, persons with chronic pain are ready to allocate a significant portion of their total annual family income to minimize PRM. Furthermore, treatment and management strategies that focus on reducing pain intensity would have the greatest impact on improving health related quality of life.