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Background: Chronic pain affects multiple aspects of life, including employment, functioning, interpersonal relationships, and overall quality of life. Approximately one-fifth of the European population experiences chronic pain. Yet, research and public policy have devoted limited attention to this condition, despite its substantial societal costs, including reduced productivity and high healthcare utilisation. The Interdisciplinary Pain Rehabilitation Programme (IPRP) is an evidence-based treatment provided in specialist care. However, it remains largely underutilised in primary care, where the majority of chronic pain patients are managed. Implementing the IPRP requires coordinated professional efforts and substantial initial resources, which can hinder its adoption. Current health-economic evaluations are limited, short-term, and inconclusive, casting doubt on the programme’s long-term effectiveness. 

Aims: The overall aim of this thesis was to study the health economic implications of IPRPs in primary care from both a societal and healthcare provider perspective. Study I aimed to evaluate patient-reported outcomes and healthcare utilisation one year before and after a case manager-led IPRP. Study II aimed to analyse the cost-effectiveness of IPRP compared with care as usual. Study III aimed to analyse healthcare utilisation and costs one year before and after IPRP. Study IV aimed to examine whether participating in IPRP in primary or specialist care is associated with background variables, pain characteristics, quality of life, anxiety, and depression.

Methods: Study I compared patient-reported outcomes and healthcare utilisation one year before and after assessment using non-parametric analyses, the Wilcoxon Signed Rank and Mann-Whitney U tests. Study II applied a cost-utility analysis to evaluate the cost-effectiveness of IPRPs compared with usual care in primary care. In Study III, healthcare utilisation and costs during the 1 year before and after IPRP were analysed by linking regional registry data to participants. Paired t-tests were used for comparative parametric analyses (Study III). The distribution of resources was compared one year before and one year after IPRP (Studies I and III). Study IV used logistic regression to identify factors associated with participation in IPRP in primary or specialist care.

Results: In Study I, reduced healthcare utilisation after IPRP was associated with increased activity levels, improved health-related quality of life, and fewer general practitioner visits. Increased healthcare utilisation was associated with higher pain intensity and a lack of psychological support at baseline and greater use of specialist services. The cost-utility analysis carried out in Study II indicated that IPRP in primary care is cost-effective, particularly in the long term. In Study III, healthcare utilisation decreased by 16% and costs by 12% the year after IPRP. This was mainly due to fewer consultations with general practitioners and physiotherapists. Study VI showed that women, individuals with university education, and those with frequent general practitioner visits were more likely to participate in IPRP in specialist care. Persistent pain and multiple pain sites also increased the likelihood of specialist referral. In contrast, obesity, high pain intensity, higher pain catastrophising, and better general health were associated with participation in IPRP in primary care. 

Conclusion: IPRP enhances health-related quality of life and reduces sickness absence to an extent that supports its cost-effectiveness compared with usual care, especially in the long run. Reduced healthcare utilisation, especially visits to general practitioners and physiotherapists, generated cost savings and freed resources in the primary care centre. Early biopsychosocial intervention, including psychological support, may improve well-being and limit unnecessary healthcare use. Reorganising primary care resources could strengthen chronic pain management and support the broader implementation of IPRP. Socioeconomic factors appear to influence referral pathways, resulting in unequal access to healthcare and inefficient use of healthcare resources. Straightforward guidelines are needed to ensure that patients with lower rehabilitation needs receive treatment in primary care, while those with greater needs access specialist rehabilitation.

OBJECTIVES: Most patients with chronic pain are identified and managed in primary care (PC). Chronic pain management is challenging, which is manifested by increased healthcare utilization (HCU) in this patient group. The interdisciplinary pain rehabilitation program (IPRP) is the gold standard treatment for patients with chronic pain but is scarcely used in PC. The aim of this study was to evaluate the HCU of patients with chronic pain in PC 1 year before and 1 year after an IPRP by examining the distribution of costs and resources.

METHODS: This retrospective cohort study combined data from a national pain registry and HCU data from regional administrative registries, including 146 patients who participated in an IPRP in PC. The outcome measure was the number of outpatient healthcare contacts. Costs and the distribution of resources were compared across the two measurement intervals using paired t-tests. HCU costs were described from a healthcare provider perspective.

RESULTS: HCU decreased by 16% in the year following IPRP compared to the year before. Costs for outpatient visits dropped by 12% or €434 per participant. Visits to physiotherapists and general practitioners decreased the most, by 31% (p = 0.048) and 23% (p < 0.001) respectively. Visits to nurses, occupational therapists, and psychologists/social workers in turn increased marginally (6%, 5% vs 10%).

CONCLUSIONS: IPRP in PC may lead to reduced HCU, freed resources, and streamlined chronic pain management. The study offers valuable insights into expected changes in HCU for chronic pain patients after an IPRP and how these changes may impact daily activities at the PC center.

Objective: To evaluate patient-reported outcome measures in patients with chronic musculoskeletal pain 1 year after participation in a case manager-led multimodal rehabilitation intervention in a Finnish primary care centre. Changes in healthcare utilization (HCU) were also explored.

Methods: A prospective pilot study with 36 participants. The intervention consisted of screening, multidisciplinary team assessment, a rehabilitation plan and case manager follow-up. Data were collected through questionnaires filled in after the team assessment and 1 year later. HCU data 1 year before and 1 year after team assessment were compared.

Results: At follow-up, satisfaction with vocational situation, self-reported work ability and health-related quality of life (HRQoL) had improved and pain intensity had diminished significantly for all participants. The participants who reduced their HCU improved their activity level and HRQoL. Early intervention by a psychologist and mental health nurse was distinctive for the participants who reduced HCU at follow-up.

Conclusion: The findings demonstrate the importance of early biopsychosocial management of patients with chronic pain in primary care. Identification of psychological risk factors at an early stage may lead to better psychosocial wellbeing, improve coping strategy and reduce HCU. A case manager may free up other resources and thereby contribute to cost savings.

Objectives: Multimodal rehabilitation programs (MMRPs) have been shown to be both cost-effective and an effective method for managing chronic pain in specialist care. However, while the vast majority of patients are treated in primary healthcare, MMRPs are rarely practiced in these settings. Limited time and resources for everyday activities alongside the complexity of chronic pain makes the management of chronic pain challenging in primary healthcare and the focus is on unimodal treatment. In order to increase the use of MMRPs incentives such as cost savings and improved health status in the patient group are needed. The aim of this study was to evaluate the cost-effectiveness of MMRPs for patients with chronic pain in primary healthcare in two Swedish regions. The aim of this study was to evaluate the cost-effectiveness of MMRPs at one-year follow-up in comparison with care as usual for patients with chronic pain in primary healthcare in two Swedish regions.

Methods: A cost-utility analysis was performed alongside a prospective cohort study comparing the MMRP with the alternative of continuing with care as usual. The health-related quality of life (HRQoL), using EQ5D, and working situation of 234 participants were assessed at baseline and one-year follow-up. The primary outcome was cost per quality-adjusted life year (QALY) gained while the secondary outcome was sickness absence. An extrapolation of costs was performed based on previous long-term studies in order to evaluate the effects of the MMRP over a five-year time period.

Results: The mean (SD) EQ5D index, which measures HRQoL, increased significantly (p<0.001) from 0.34 (0.32) to 0.44 (0.32) at one-year follow-up. Sickness absence decreased by 15%. The cost-utility analysis showed a cost per QALY gained of 18 704 € at one-year follow-up.

Conclusions: The results indicate that the MMRP significantly improves the HRQoL of the participants and is a cost-effective treatment for patients with chronic pain in primary healthcare when a newly suggested cost-effectiveness threshold of 19 734 € is implemented. The extrapolation indicates that considerable cost savings in terms of reduced loss of production and gained QALYs may be generated if the effects of the MMRP are maintained beyond one-year follow-up. The study demonstrates potential benefits of MMRPs in primary healthcare for both the patient with chronic pain and the society as a whole. The cost-effectiveness of MMRPs in primary healthcare has scarcely been studied and further long-term studies are needed in these settings.