Estimating the direct healthcare utilization and cost of musculoskeletal pain among people with comorbidity: a retrospective electronic health record study

Abstract

Objective

To investigate the impact of pre-existing painful musculoskeletal conditions on healthcare utilization and costs among patients with five common conditions: acute coronary syndrome (ACS), stroke, cancer, dementia and pneumonia.

Methods

Using primary and secondary care services data from electronic health records, a negative binomial regression model was used to compare resource use while a two-part model was used to compare costs across the five conditions, between those with and without a pre-existing musculoskeletal pain.

Results

The study included 760,792 patients (144,870 with ACS, 121,208 with stroke, 231,702 with cancer, 134,638 with dementia, and 128,374 with pneumonia) in the complete case analysis. Pre-existing musculoskeletal pain had an incident rate ratio of above one for most healthcare resources over the follow-up period and an adjusted additional mean cumulative total healthcare costs per patient of £674.59 (95%CI 570.30 to 778.87) for ACS; £613.34 (95%CI 496.87 to 729.82) for stroke; £459.26 (95%CI 376.60 to 541.91) for cancer; and £766.23 (95%CI 655.06 to 877.39) for dementia over five years after diagnosis; and £200.85 (95%CI 104.16 to 297.55) for pneumonia over one year after diagnosis compared to those without musculoskeletal pain.

Conclusion

This study highlights that individuals with painful musculoskeletal conditions have higher healthcare utiliszation and costs than those without painful musculoskeletal conditions. Given the high occurrence of musculoskeletal pain in patients with other conditions, effective management strategies are needed to reduce the burden on healthcare resources.

Keywords:

• Cost
• pain
• musculoskeletal
• comorbidity

Transparency

 

Declaration of financial/other relationships

The Keele School of Medicine has received funding from the British Medical Society for a non-pharmacological atrial fibrillation screening trial. The authors have no further conflicts to declare.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All authors contributed to the study's conception and design. Data collection was performed by KJM and JB. Data analysis was performed by MEP. The first draft of the manuscript was written by MEP, MM, KPJ and FA. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Acknowledgements

Clinical Practice Research Datalink (CPRD) Data: This study is based in part on data from the Clinical Practice Research Datalink obtained under licence from the UK Medicines and Healthcare products Regulatory Agency. The data is provided by patients and collected by the NHS as part of their care and support. The interpretation and conclusions contained in this study are those of the authors alone. Office of National Statistics (ONS) Data: The interpretation and conclusions contained in this study are those of the authors alone. Hospital Episode Statistics (HES) Data/ONS Data: Copyright © 2020, re-used with the permission of The Health & Social Care Information Centre. All rights reserved. OPCS: The OPCS Classification of Interventions and Procedures, codes, terms and text is Crown copyright (2016) published by Health and Social Care Information Centre, also known as NHS Digital and licensed under the Open Government Licence available at www.nationalarchives.gov.uk/doc/open-government-licence/open-government-licence.htm.

Patient and public involvement and engagement (PPIE): The authors would especially like to thank the members of the Keele Research User Group for their valuable contributions to this study. We are also thankful to Keele PPIE team for their support of the public contributors.

Project advisory group (PAG): The authors would also like to thank the Project Advisory Group for the MSKCOM study.

Data availability statement

Data may be obtained from a third party and are not publicly available. The data were obtained from the Clinical Practice Research Datalink. Clinical Practice Research Datalink data governance does not allow us to distribute patient data to other parties. Researchers may apply for data access at http://www.CPRD.com/.

Additional information

Funding

This project was funded by the Nuffield Foundation (OBF/43974). The Nuffield Foundation is an independent charitable trust with a mission to advance social well-being. It funds research that informs social policy, primarily in Education, Welfare, and Justice. It also funds student programmes that provide opportunities for young people to develop skills in quantitative and scientific methods. The Nuffield Foundation is the founder and co-founder of the Nuffield Council on Bioethics and the Ada Lovelace Institute. The Foundation has funded this project, but the views expressed are those of the authors and not necessarily of the Foundation. Visit www.nuffieldfoundation.org. KJM, KPJ and CDM are also supported by matched funding awarded to the NIHR Applied Research Collaboration West Midlands. CDM is also funded by the NIHR School for Primary Care Research.