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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.