Economic Impact Of Back Pain Substantial

The researchers said that their results not only demonstrate the enormous economic impact of back pain, but provide concrete data that policy makers and researchers can use in determining how health-care resources should be allocated.

The Duke team mined data from the Medical Expenditure Panel Survey (MEPS) in 1998. The MEPS is a national survey conducted by the Agency of Healthcare Research and Quality (AHRQ) and the National Center for Health Statistics. The team found that 25.9 million adults reported back pain in 1998, with 172.7 million reporting no back pain.

"To put these expenses in perspective, the total $90 billion spent in 1998 represented 1 percent of the U.S. Gross Domestic Product (GDP), and the $26 billion in direct back pain costs accounted for 2.5 percent of all health care expenditures for that year," said lead researcher Xuemei Luo, Ph.D., who published the results of the Duke study today (Jan. 1, 2004) in the journal Spine.

"We believe that the results of our analysis highlight the prevalence of back pain in the U.S. and its impact on the health-care system," Luo continued. "Not only are the costs enormous, but they vary widely across patients with different clinical, socioeconomic and demographic backgrounds. Significant health-care savings could be achieved if this population of patients received more cost-effective and targeted treatments."

For the purposes of their study, back pain was defined as pain experienced in any portion of the back, whether it be caused by back disorders, disc disorders or injuries to the back at some point during 1998.

The population of 25.9 Americans adults who reported back pain tended to be female (55 percent), white (88.3 percent), and married (61 percent), with an average age of 48.

In their analysis, the researchers looked at such cost categories as in-hospital costs, office-based visits, hospital outpatient visits, emergency room visits, prescription medications and home health services. For office-based and outpatient services, in addition to physician visits, the survey also measured visits to such health-care providers as chiropractors, physical therapists, psychologists and nurses.

The annual per capita expenditures for patients with back pain were 1.6 times higher than those without back pain -- $3,498 vs. $2,177. These increased expenditures were found in all categories:

-- Inpatient charges: $1,075 vs. $774

-- Office visits: $910 vs. $425

-- Prescription drugs: $541 vs. $340

-- Outpatient care: $460 vs. $248

-- Home health $105 vs. $92

-- Emergency room: $102 vs. $61

"We found that health-care expenditures were not equally distributed among patients with different levels of expenditures," Luo explained. "For example, in each of the health services, the top 10 percent most expensive patients accounted for more than half of the total expenditures. Furthermore, the 25 percent most expensive patients accounted for more than 75 percent of the total expenditures."

As would be expected, the researchers found that elderly patients with back pain incurred higher expenditures compared to younger patients.

"We also found that females incurred higher average expenditures than males," Luo said. "The reason for this difference is not clear and needs further investigation.

"Also, the fact that white patients as well as patients who had medical insurance had higher per capita expenses suggests that there may be some barriers to care for those who are African-American or uninsured," Luo said.

However, when compared to those with private insurance, patients who had government-supported insurance had higher expenditures, especially in the areas of inpatient care, home health services and prescription drugs.

"Since these two groups are insured, it would be interesting to investigate whether the difference in the expenditures is caused by the differences in the insurance programs," Luo said.

Luo's research was supported by Duke's Center for Clinical Effectiveness, part of the department of surgery.

Other members of the team were, from Duke, Ricardo Pietrobon, M.D., and Lloyd Hey, M.D. Other team members included Shawn Sun, Ph.D., and Gordon Liu, Ph.D., of the University of North Carolina, Chapel Hill.