Navigating perinatal mental health care: migrant women's experiences of support pathways and the role of digital resources.

Chronic pain can be a debilitating condition that frequently co-occurs with other physical and mental health disorders, negatively impacting individuals’ quality of life. Pain that last for 3 months or longer and interferes with important life or work activity is classified as “high-impact” musculoskeletal chronic pain (HICP) and impacts more than 20 million U.S. adults. HICP is more prevalent among individuals residing in rural areas, disproportionately impacting their wellbeing and functioning. Despite the consequential higher need for treatment options, rural regions typically have fewer resources available for chronic pain treatment. Cognitive behavioral therapy for chronic pain (CBT-CP), including therapies delivered via remote methods, has been shown to be an effective treatment option for chronic pain generally, with emerging evidence that it may be particularly effective for those with HICP. For residents of rural communities, the ability to deliver CBT-CP based therapies remotely may be particularly important for improving access. The RESOLVE study was a comparative effectiveness, 3-group randomized clinical trial designed to test two remote, scalable CBT-CP-based interventions: 1) a health coach-led telephonic/videoconferencing program (health coach) and 2) an established online, self-completed program (painTRAINER) relative to usual care (UC) services and each other. The RESOLVE study found that these remote CBT-CP-based interventions were effective in achieving clinically important reductions in pain severity among individuals with HICP. In this paper we report the results of the cost-effectiveness analysis (CEA), from the health plan perspective, for the RESOLVE study. We evaluate the cost-effectiveness of the two remote CBT-CP-based interventions relative to UC as well as to one another. We conducted the CEA using the framework of cost-effectiveness, including the costs of implementation and maintenance, following best practice in economic evaluation.