The economic burden of chronic back pain in the United States : a societal perspective

Back pain is the 6th most costly condition in the United States and is responsible for the most workdays lost. Approximately 33 million American adults suffered from back and neck problems in 2005. The societal cost of chronic back pain (CBP) has not been calculated from a US perspective. Longitudinal data files from Panels 12, 13, and 14 of the Medical Expenditure Panel Survey (MEPS) were used to estimate excess direct (ambulatory visits, inpatient admissions, emergency room visits, and prescription medication) costs and indirect (lost productivity) costs for persons 18 years and older reporting CBP compared to those not reporting back pain. Persons were included in the CBP group if they reported back pain (ICD-9-CM codes 720, 721, 722, 723, 724, 737, 805, 806, 839, 846, 847) in at least 3 consecutive interview rounds. The complex sampling design of MEPS was taken into account to get accurate national estimates. All costs were adjusted to 2011 using Consumer Price Indices. All mean costs were computed using age-stratified regression models, after adjusting for demographic and clinical covariates. Utilization of provider-based complementary and alternative medicine (CAM) among CBP patients was studied, and differences in costs between CAM users and non-users examined. Based on this analysis, the prevalence of CBP in the adult US population was estimated to be 3.76%. Total all-cause costs for CBP patients were estimated to be $187 billion over 2 years (direct costs = $176 billion, indirect cost = $11 billion). Overall estimates of excess costs of CBP over 2 years per person for direct medical costs were $37,129 ($25,273 vs. $48,984; p<0.001). This breaks down to $11,711 ($14,929 vs. $3,219; p<0.001) for ambulatory visits; $3,560 ($6,514 vs. $2,914; p<0.001) for inpatient admissions; $300 ($690 vs. $390; p<0.001) for emergency department visits; and $19,849 ($23,873 vs. $4,024; p<0.001) for prescription medications. Excess indirect costs for CBP patients were $1,668 ($2,329 vs. $661; p<0.001). Thirty-seven percent of CBP patients reported at least one CAM visit. There was no significant difference in overall costs between CAM users and non-users. The high cost of chronic back pain in the US population has potential implications for prioritizing policy, and in attempting to improve care and outcomes for these patients.