Healthcare utilization of back pain patients: results of a claims data analysis

Abstract

Objectives:

The high life-time prevalence of chronic back pain (25–30% according to surveys in small samples) suggests that it may be a major source of healthcare cost and that prevention of chronic back pain may be both ethically and economically recommendable. To obtain valid economic data on the cost of back pain in Germany, a retrospective claims data analysis was performed.

Methods:

Using data from 2006 of 5.2 million beneficiaries of a German statutory health insurance fund (DAK Unternehmen Leben) covering ∼7% of the German population, mean value analyses report on key healthcare utilization figures from a sickness funds’ perspective. In contrast to other studies, cost data are primary data and not extrapolated, but clinical characteristics include surrogate markers as no clinical case descriptions were available.

Results:

Based on previously investigated diagnosis patterns three types of back pain could be identified: (other) specific back pain (n = 211,216), pain due to spinal disk disease (n = 195,712), and non-specific back pain (n = 534,272). Of all back pain patients, 25.8% were identified as at risk to develop chronic pain, where only 2.6% were detected as patients with chronic back pain. Mean resource utilization and related healthcare costs were significantly higher for beneficiaries with indicators for chronic back pain than for beneficiaries with only risk factors for developing chronic back pain. This especially holds for outpatient analgesic prescriptions (p < 0.05), for in-hospital multimodal pain therapy (p < 0.05), for in-hospital care in general (p < 0.05), as well as for direct cost of care (p < 0.05).

Conclusion:

The results show the potential that could be made accessible by an early detection of back pain patients who bear a risk of pain becoming chronic, both in terms of quality-of-life as well as in financial terms.

Keywords::

• Back pain
• Chronic back pain
• Resource utilization
• Comorbidity
• Claims data

Transparency

Declaration of funding:

This study was funded by Grunenthal GmbH, Germany, manufacturer of opioids, and executed by the IGES Institute, Germany. The project was overseen by an advisory board with delegates from the German Society for the Study of Pain e.V. (DGSS: RDT), German Society for Pain Therapy e.V. (DGS: GMS), Interdisciplinary Society for Orthopedic Pain Therapy (IGOST: HRC), and Professional Association of Physicians and Psychologic Psychotherapists in Pain and Palliative Medicine in Germany e.V. (BVSD: RT). This advisory board received travel reimbursement for face-to-face meetings, but no honoraria.

Declaration of financial/other interests:

AF, GS, and AH have disclosed that they are employees of the IGES Institute, which received the financial support to execute the data analyses and publication of results described in the manuscript. GMS, AB, HRC, GG, RT, and RDT have disclosed that they are members of the advisory board to the project and do not receive financial reimbursement except for travel expenses. GG receives research grants from different health insurance funds and physician’s associations. AB, GMS, and RT occasionally give speeches on behalf of Grunenthal. RDT received research-funds, consulting fees, and remuneration from: Allergan, Astellas, Boehringer Ingelheim, Galderma, Glaxo Smith Kline, Grünenthal, Dr. Kade, Lilly, Merck, Sharpe & Dohme, Merz, Nycomed, Pfizer, Sanofi, Schwarz Pharma. CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships