Michelle Sleed

The economic impact of chronic pain in adolescence: methodological considerations and a preliminary costs-of-illness study.

&NA; Chronic pain in adulthood is one of the most costly conditions in modern western society. However, very little is known about the costs of chronic pain in adolescence. This preliminary study explored methods for collecting economic‐related data for this population and estimated the cost‐of‐illness of adolescent chronic pain in the United Kingdom. The client service receipt inventory was specifically adapted for use with parents of adolescent chronic pain patients to collect economic‐related data (CSRI‐Pain). This method was compared and discussed in relation to other widely used methods. The CSRI‐Pain was sent to 52 families of adolescents with chronic pain to complete as a self‐report retrospective questionnaire. These data were linked with unit costs to estimate the total care cost package for each family. The economic impact of adolescent chronic pain was found to be high. The mean cost per adolescent experiencing chronic pain was approximately £8000 per year, including direct and indirect costs. The adolescents attending a specialised pain management unit, who had predominantly non‐inflammatory pain, accrued significantly higher costs, than those attending rheumatology outpatient clinics, who had mostly inflammatory diagnoses. Extrapolating the mean total cost to estimated UK prevalence data of adolescent chronic pain demonstrates a cost‐of‐illness to UK society of approximately £3840 million in one year. The implications of the study are discussed.

The Bath Adolescent Pain Questionnaire (BAPQ): development and preliminary psychometric evaluation of an instrument to assess the impact of chronic pain on adolescents

&NA; Chronic pain causes significant problems in the lives of many adolescents, considerably affecting their physical, psychological and social functioning. The assessment of the multidimensional impact of chronic pain is an essential clinical task. This study reports on the development and psychometric evaluation of the Bath Adolescent Pain Questionnaire (BAPQ); an assessment tool designed specifically for use with adolescents who experience chronic pain. A sample of 222 adolescents (11–18 years) experiencing chronic pain completed the 109‐item draft inventory. Participants were recruited from two different UK clinics. All participants responded to items using a 5‐point frequency scale. Psychometric evaluation of the data resulted in a reduced inventory length of 61 items. Internal consistency of all seven questionnaire subscales was established using Cronbachs alpha. Comparative validity was undertaken by comparison of all individual subscales with existing validated measures (SCAS, CDI‐S, FDI, Brief FAM. PCS and CASAFS). The temporal reliability of each inventory subscale was established using a sub‐sample of 30 adolescent participants over a 17‐day period. Psychometric evaluation of the data suggests the inventory yields both a reliable and valid assessment of the impact of chronic pain on the lives of adolescents. The BAPQ may offer a comprehensive way to assess the widespread deleterious impact of adolescent chronic pain in both a research and clinical setting. Further investigation is needed on the predictive validity of the subscales. Additional data from samples of patients with diagnoses that are not musculoskeletal in origin would be of great assistance.

Development and preliminary psychometric evaluation of the parent report version of the Bath Adolescent Pain Questionnaire (BAPQ-P): A multidimensional parent report instrument to assess the impact of chronic pain on adolescents.

Abstract Assessing the experience and impact of pain in adolescents with chronic pain is necessary to guide both individual treatment and to inform treatment development. Ideally, to obtain a comprehensive understanding of the impact of pain, assessment should be multidimensional, should be sensitive to contextual variables, and should allow for multiple informants (in particular, parents). The purpose of this study was to develop a standardized parent‐report measure of chronic pain in adolescents, the Bath Adolescent Pain Questionnaire – Parent report (BAPQ‐P). Participants included 222 adolescents with chronic pain and their parents recruited from two specialty clinics in the UK. The adolescents completed a battery of self‐report inventories related to their pain and daily functioning whilst parents completed the BAPQ‐P and additional measures of adolescent functioning. Scales of the BAPQ‐P emerged to be internally consistent and temporally stable over a 17‐day period. Validity was examined in relation to existing validated child report measures of anxiety, depression, catastrophizing, disability, family, and social functioning and parent report measures of disability and family functioning. Psychometric evaluation suggests that the BAPQ‐P is a reliable and valid parental report tool for assessing the multidimensional impact of adolescent chronic pain. It can be used in conjunction with the previously established adolescent self‐report measure, the BAPQ, alone where adolescent self report is not possible, in studies where parent report is the focus, or in studies where concordance between parent and adolescent reports is of interest.

The costs of alcoholism

Background: Alcohol dependence is one of the most common psychiatric disorders, placing many health, social and economic burdens upon society. Aims: To review evidence regarding the socioeconomic burden of alcoholism and the cost-effectiveness of available treatments. Methods: Relevant literature was identified from searches of electronic databases covering the period from 1980 to February 2002. Results: Total economic costs to society from alcohol abuse have been estimated at

Effectiveness and costs of acute day hospital treatment compared with conventional in-patient care - Randomised controlled trial

148 billion (1992) in the USA, DM6 billion (€3.1 billion, 1990) in West Germany and 638 billion ptas (€3.8 billion, 1996) in Spain. Lost productivity costs far outweighed direct medical costs in each of these countries. Regarding comparative cost-effectiveness evidence, no economic evaluations could be identified on specific interventions, except the several modelling studies that have been published recently on acamprosate. They showed potential cost savings by acamprosate, primarily through reduced acute hospitalization and rehabilitation. Existing effectiveness and cost data suggest that brief motivational counselling is also a potentially cost-effective intervention. A few papers examining the cost-effectiveness of different treatment programmes were also reviewed. Conclusions: Results of this review further emphasize the necessity of efficient resource allocation in health care and the need for comprehensive, standardized management strategies for people with alcohol abuse.