Budget Impact Analysis of Integrative Medicine Practices for Pediatric Patients With Chronic Pain

Abstract

Objectives: Chronic pain is a leading cause of morbidity in children and adolescents globally but can be managed with a combination of traditional Western medicine and integrative medicine (IM) practices. This combination has improved various critical health outcomes, such as quality of life, sleep, pain, anxiety, and health care utilization. These IM practices include acupuncture, yoga, biofeedback, massage, mindfulness, or any combination of these modalities. The current article developed a budget impact model to estimate the institutional costs of implementing these practices among adolescents.

Methods: A decision tree was used to estimate the reduction in hospitalizations and emergency department (ED) use based on a previously published retrospective analysis of children receiving IM practices comparing utilization rates 1-year pre-implementation and post-implementation of IM services (Figure 1). Costs associated with implementing each modality were based on hourly compensation rates for licensed professionals administering each service and equipment associated with delivery (eg, acupuncture needles, biofeedback equipment, and sensors). The cost of each hospitalization and ED visit was derived from the literature. In addition, cost savings were estimated based on government-contracted and commercial-contracted reimbursement rates for each service.

Results: Cost savings were approximated to range from $1344 to $3439 per patient, with even greater cost savings of up to $6000 and $4132 when accounting for governmental and commercial payer reimbursement, respectively.

Discussion: IM leads to improved pain relief when combined with traditional medicine and yields significant cost savings, thus supporting the routine implementation of IM alongside traditional medicine in health care settings.

FIGURE 1

A simple decision tree was used to estimate the budget impact. Chronic pain patients enrolled in IM services are expected to experience a reduction in emergency department (ED) visits and hospitalization rates compared with pre-enrolment, which will affect their total downstream health care utilization and subsequent costs. These 3 outcomes (ED visit, hospitalization, and discharged home from IM service) were each assigned an aggregate cost to account for the management of IM patients in each setting.

FIGURE 2

This figure presents a comparative analysis of integrative medicine (IM) services, detailing the utilization costs before and after implementation, the direct costs of the services, and the net cost impact.

FIGURE 3

This tornado diagram illustrates the impact of varying individual model parameters on the cost savings calculated. The diagram presents the most sensitive model parameters to the least sensitive. The values shown reflect the range of possible cost savings associated with changing that specific parameter from its minimum to maximum value. For example, when varying the probability of pre-IM hospitalization from 2.36% to 5.65%, cost savings range from $1065 to $10,231. Based on the analysis, the probability and cost of hospitalization preintervention, followed by the reduction in hospitalization rates and cost postintervention have the most significant impact on the model results. The cost to provide the service had minimal impact on cost savings. Results are shown for acupuncture only for clarity; however, these results remained consistent across different treatment modalities.