Download presentation
Presentation is loading. Please wait.
Published byRosamond Higgins Modified over 9 years ago
1
Economics of spine-related disability: Societal costs Simon Dagenais, DC, PhD, MSc 1
2
Spine-related 2 Low back pain Nonspecific Neurological / radiculopathy Serious spinal pathology (e.g. tumor, fracture, infection, arthritides) Neck pain Nonspecific Neurological / radiculopathy Serious spinal pathology (e.g. tumor, fracture, infection, arthritides) Other Pediatric / congenital Scoliosis / deformity Spinal cord injury Other
3
Epidemiology 3 Low back pain Point prevalence (now)28.4% Lifetime prevalence (ever)84.1% 6 month prevalence71.9% Low intensity / low disability48.9% High intensity / low disability12.3% High intensity / high disability10.7% Cassidy, 1998 (PMID 9762743)
4
Health services utilization – Primary care 4 Low back pain #1 reason for visiting a chiropractor #1 reason for visiting a physical therapist #2 reason for visiting a primary care physician Hurwitz, 1998 (PMID 9585743) Bekkering, 2003 (PMID 12952520) Bigos, 1996 (PMID 8892135)
5
Health services utilization – Specialist care 5 Low back pain #1 reason for visiting an orthopedic surgeon #1 reason for visiting a neurologic surgeon #3 reason for obtaining elective surgery Hurwitz, 1998 (PMID 9585743) Bekkering, 2003 (PMID 12952520) Bigos, 1996 (PMID 8892135)
6
Health services utilization – ED Low back pain ~2% of all ED visits (2.6 million each year in US) Diagnostic testing 31% had x-rays 10% had CT or MRI 19% had urinalysis 10% had blood work Prescription medication 61% received opioids 50% received NSAIDs 43% received muscle relaxants Friedman, 2010 (PMID 21030902) 6
7
Health services utilization – Opioids Low back pain #1 indication (~50% of users) Opioid overdose One of the leading causes of accidental death (16,651 in 2010) 7 Edlund, 2010 (PMID 20634006) Okie, 2010 (PMID 21083382) 2015 ?
8
Economic impact 8 Also known as cost of illness, burden of illness Attempt to measure the economic consequences of a specific health condition Think of anything that may change with a health condition Try to put a price tag on it Add it all up Goal is to inform decision making for stakeholders Allocate resources to address health condition
9
Systematic review 9 Main goal was to look at how others had already tackled this issue
10
Systematic review 10 Identified 27 studies from 8 different countries Australia, Belgium, Japan, Korea, Netherlands, Sweden, UK, US All defined back pain differently e.g. self-reported vs. ICD-9 codes, >3/6/12 months Differed in the scope of costs considered 14 examined direct / health care costs 18 examined indirect / productivity costs 8 examined both direct and indirect costs
11
Direct / health care costs 11 Studies did not all consider different types of health care When studies looked for specific costs, they found them
12
Indirect / productivity costs 12 Absenteeism Formal (e.g. temporary paid leave) Informal (e.g. personal time off) Presenteeism Self-reported Estimated by supervisor Early retirement Government Private Inactivity Forfeited leisure time Household productivity Paid Unpaid
13
Indirect / productivity costs 13 Human capital approach Productivity losses based on remaining lifespan e.g. 35 year-old with back pain is losing out on 30 years of productivity 30 years x $50,000/year = $1.5 million Friction approach Assumes injured workers are eventually replaced e.g. 35 year-old IT engineer replaced in 6 months 6 months x $100,000/year = $50,000
14
Total costs 14
15
Total costs 15 Indirect (85%) Direct (15%) Inpatient 2.6% Physical therapy 2.6% Pharmacy 2.0% Primary care 2.0% Outpatient 1.2% Imaging 1.1% Specialists 1.1% Chiropractic 0.8% Other 0.8% Surgery 0.8% CAM 0.3% Emergency 0.2% Mental health 0.2% Sick leave61.2% Early retirement11.9% Presenteeism6.8% Household3.4% Inactivity0.9%
16
Findings for US 16 No study measured both direct and indirect costs Direct costs $12.2 - $90.6 billion Indirect costs $7.4 - $28.2 billion In other countries that examined both: Direct costs were 3 - 66% of total (median 15%) Indirect costs were 34 - 97% of total (median 85%) Based on proportions observed in other countries Total costs in US could be $84.1 - $624.8 billion
17
Findings for US 17 2015 $162 billion Self-reported disability increased by 25% (From 20% with spine problems to 25%) Martin, 2008 (PMID 18270354)
18
Other considerations 18 Costs higher if we include all spine-related conditions ~5-10% of total health care costs depending on scope Costs don’t fully reflect cases associated with workers’ compensation or personal injury Legal, administrative, health care No estimate of costs for back problems related to Social Security Disability or Department of Defense One of the leading causes
Similar presentations
© 2025 SlidePlayer.com. Inc.
All rights reserved.