What are the costs of managing neck and low back pain in Brazil? Investigation of a ten-year period from the perspective of the Brazilian public health system.

INTRODUCTION: Considering the prospects of increased prevalence and disability due to neck and low back pain, it is relevant to investigate the care processes adopted, to assist future public policies and decision-making for a better allocation of resources. Objective: the aim of this study was to estimate the costs arising from inpatient and outpatient care of individuals with Neck Pain (NP) and Low Back Pain (LBP) in Brazil, between 2010 and 2019. METHODS: This is a cost-of-illness study from the perspective of the Brazilian public health system, based on health conditions with high prevalence (neck and low back pain). Data were presented descriptively using absolute and relative values. RESULTS: Between 2010 and 2019, the health system spent more than $600 million (R$ 2.3 billion) to treat NP and LBP in adults, and LBP accounted for most of the expenses. Female had higher absolute expenses in inpatient care and in the outpatient system. CONCLUSION: Our study showed that the costs with NP and LBP in Brazil were considerable. Female patients had higher outpatient costs and male patients had higher hospitalization costs. Healthcare expenses were concentrated for individuals between 34 and 63 years of age.

This study focused on understanding how much it cost to treat neck pain (NP) and low back pain (LBP) in Brazil between 2010 and 2019, from the point of view of the public health system (i.e. Unified Health System ­ SUS). The idea was to find out how much money was spent and where. It turned out that the SUS spent, in total, more than US$600 million (R$2.3 billion) with LBP responsible for most of these expenses. Furthermore, we noted that women had higher outpatient care costs, while men had higher hospitalization costs. Those costs were more concentrated in people aged between 34 and 63 years.

Low back pain should be considered a health and research priority in Brazil: Lost productivity and healthcare costs between 2012 to 2016.

BACKGROUND: Low Back Pain (LBP) is associated with an increase in disability-adjusted life years, and increased risk of disability retirement and greater absenteeism in Brazil. Hence, evidence on healthcare and lost productivity costs due to LBP is of utmost importance to inform decision-makers. METHODS: Cost-of-illness study with top-down approach, and societal perspective. We extracted data from National databases, considering the period 2012-2016. Outpatient expenses included clinical, surgical, diagnosis, orthosis/prosthetics, and complementary actions. Inpatient care expenses included hospital and professional services, intensive care unit, and companion stay. For productivity losses, duration of work absence and associated information (work-related and non-work-related; value of the sickness absence benefit; age; gender; and economic activity) were analyzed. Lost productivity costs were calculated multiplying the absence from work (days) by the daily-benefit. RESULTS: The societal costs amounted to US$ 2.2 billion, and productivity losses represented 79% of the costs. Total healthcare expenses were estimated to US$ 460 million. We found more than 880,000 diagnostic images. Individuals with LBP were in total 59 million days absent from work between 2012-2016. The mean lost days absent from work per person, for each year investigated was, respectively, 88; 84; 83; 87; and 100. Men were more days absent from work than women. In addition, rural workers presented greater absence from work compared to other professional activities. CONCLUSION: Healthcare expenses and lost productivity costs due to LBP were substantial, hence, there is a need for improvement of health services and policies to deal with this increasing burden of illness. We found an extensive use of diagnostic imaging, which is rather discouraged by clinical guidelines. We assume that men were experiencing high levels of back pain disability compared with women, as they presented greater absenteeism and higher lost productivity costs.

Costs Associated with the Treatment of Low Back Disorders: A Comparison of Surgeons and Physiatrists.

BACKGROUND: Spine care is costly and subject to wide variability. Defining costs and patterns of care for different specialties is critical to improving value. OBJECTIVE: Determine costs, utilization, and differences therein for nonoperative and operative specialists in treating low back disorders. We hypothesized costs associated with nonoperative specialists would be lower. DESIGN: Retrospective cohort. SETTING: Medicare Limited Data Set (5% sample), 2011 to 2014. PARTICIPANTS: A total of 170 011 patients saw a primary care provider for a low back disorder between 1 July 2011, and 1 January 2013. Excluding those seen for a low back disorder in the preceding 6 months, final cohorts totaled 11 829 patients subsequently evaluated by a physiatrist (specialist in physical medicine and rehabilitation; 3183 patients) or surgeon (orthopedic or neurosurgeon; 8646 patients) within the following 6 months. MAIN OUTCOME MEASURES: Total Medicare expenditures, spine-specific costs, spine surgical rates over 24 months. RESULTS: Cohorts had comparable demographics, initial diagnoses, and baseline mean per-member per-month (PMPM) total spending. Mean 2-year spine-specific spending was $3978 for the physiatrist cohort and $7387 for the surgeon cohort. Comparatively, the physiatrist cohort had lower total mean 2-year spine-specific spending (-$3409; 95% confidence interval [CI] -$3824 to -$2994), mean PMPM total spending (-$122/mo; CI -$184 to -$60), and surgical rate (7.8% vs. 18.9%, risk ratio [RR] = 0.41; CI 0.36-0.47). Surgery predominantly drove cost differential. Mean PMPM total spending for both cohorts remained elevated at 24 months compared to baseline mean spending (physiatrist: +$293; CI $447 to $138; surgeon: +$325; CI $425 to $225). CONCLUSIONS: Following a new episode of a low back disorder, substantial costs were seen for those subsequently evaluated by a physiatrist or surgeon. Costs were considerably lower for those first seen by a physiatrist. Patients in both cohorts displayed long-term increases in health care costs. Our data suggest that early engagement in nonoperative care, when appropriate, may improve value.

Burden of Disease Attributable to Obesity and Overweight in Colombia.

OBJECTIVES: To estimate the burden of disease attributable to obesity and overweight conditions using disability-adjusted life-years (DALYs) in Colombia. METHODS: The burden of disease was estimated following an adapted methodology published by the World Health Organization. A selection of diseases was performed in which overweight and obesity are risk factors. DALYs were calculated by obtaining the proportion of cases and deaths of every disease that can be attributable to obesity and overweight conditions. The economic impact of obesity was calculated by multiplying the cost of care per patient for each comorbidity by the number of cases attributable exclusively to obesity. RESULTS: A total of 997 371 DALYs were estimated, 45% of which corresponded to men; 81% of DALYs corresponded to years lived with disability. Conditions with greater attributable DALYs are, in order, hypertension (31.6% of the total DALYs), type 2 diabetes mellitus (28.0%), cardiac ischemic disease (14.6%), and lower back pain (11.2%). An estimation of 20.5 DALYs per 1000 inhabitants was made. The economic impact of care for comorbidities associated with obesity could amount to $2158 million. CONCLUSIONS: Obesity and overweight conditions are related to higher mortality and disability than previously estimated; effective interventions aimed at prevention and treatment will have a high impact on quality of life.

Cost-Effectiveness Data Regarding Spinal Cord Stimulation for Low Back Pain.

STUDY DESIGN: Review of published literature pertaining to spinal cord stimulation (SCS) cost data analysis. OBJECTIVE: To acquire, organize, and succinctly summarize the available literature regarding the costs associated with, and the cost-effectiveness of, SCS. SUMMARY OF BACKGROUND DATA: Chronic back and limb pain is a pervasive complaint in modern society, with estimated annual costs of medical care greater than $100 billion. The traditional standard medical management with or without intermittent surgical decompression/fusion has been plagued by high costs and inconsistent results, leading to poor patient satisfaction and functional outcome, and questions from policy makers regarding use of limited healthcare resources. Neuromodulation techniques, including SCS have recently become more common in the treatment of chronic back/leg pain, with clinical studies showing a high degree of efficacy in alleviating otherwise intractable pain. Given the relatively high upfront costs associated with the hardware and implantation, policy makers have, however, questioned their use in the framework of cost-containment and resource utilization. We reviewed the available literature summarizing cost data of SCS in chronic back and limb pain, as an understanding of these data will be vital to justify continued payment for this expensive, but often very effective, treatment modality. METHODS: We performed a PubMed literature search utilizing the following terms: "spinal cord stimulation," "SCS," "financial," "cost," "cost-effectiveness," and "cost-utility." All studies published in English and containing complete or partial cost evaluations of SCS for chronic back and limb pain were included. RESULTS: The search revealed 21 studies that evaluated cost data, with or without outcomes analysis and cost-utility analysis, for patients with chronic back and limb pain. The overwhelming majority of data presented shows that SCS is not only an effective treatment option for these patients, but also represents cost savings and efficient use of healthcare resources relative to current standards of care. Although not all studies performed cost-utility analyses, those that did tended to show SCS falling well within accepted thresholds of "willingness-to-pay" on the part of third-party payers. That being said, the articles included in this review were almost all small, retrospective, single-institution studies. In addition, many of them relied on modeling for their analyses, and published literature values for cost and/or outcomes data rather than prospectively collected patient data. Although the data presented in this review are encouraging, it should serve as a foundation for a thorough, prospective, cost-utility analysis of SCS in chronic back and limb pain so that the role of this important treatment modality may be cemented in the treatment paradigm for these patients without questions from third-party payers. CONCLUSION: The large majority of data covering costs of SCS argue in favor of the cost-effectiveness of this treatment modality for chronic neuropathic pain, especially in comparison to reoperation and medical management. Although most of the higher-quality evidence is relatively short-term, clinical experience with the durability of treatment benefit of SCS in these patients is promising. Given the pushback regarding high upfront costs of implantation, longer-term, prospective, randomized studies evaluating this topic will be important to help maintain third-party payer reimbursements for SCS. LEVEL OF EVIDENCE: 5.

Association Between Costs Related to Productivity Loss and Modified Risk Factors Among Users of the Brazilian National Health System.

OBJECTIVES: The aim of this study was to investigate the associations between costs related to productivity losses and its risk factors among users of the Brazilian National Health System. METHODS: The public cost associated with productivity losses of 342 adults has been estimated, taking into account a period of 18 months. Costs related to productivity loss were estimate using data provided by the Brazilian National Health System (disability retirements) and absenteeism. Modifiable risk factors and unhealthy behaviors were assessed through interviews (physical inactivity, alcohol consumption, and smoking) and clinical assessments (obesity). RESULTS: Smoking and physical inactivity affected significantly the amount of money lost with productivity losses related to absenteeism. The presence of obesity generated higher expenditures with disability retirement, while low back pain and sleep disorder were the most relevant confounders in multivariate models for disability retirement and absenteeism. CONCLUSIONS: Among users of the Brazilian National Health System, obesity, smoking, and physical inactivity seem to have a significant effect on productivity losses associated with health problems. Moreover, low back pain and sleep quality seem variables few explored but with potential to affect health care costs.

Costo institucional del paciente con incapacidad temporal para el trabajo por lumbalgia mecánica / Institutional cost of the patient with temporary inability to work due to mechanical low back pain

Introducción: La lumbalgia afecta de manera frecuente a la población económicamente activa. Es la primera causa de pérdida de días laborales en trabajadores menores de 55 años de edad y la segunda de ausentismo laboral. Objetivo: Determinar el costo institucional del paciente con incapacidad temporal para el trabajo por lumbalgia mecánica. Materiales y métodos: Se realizó un estudio de costos de expedientes de trabajadores con lumbalgia de 20 a 60 años con incapacidad temporal para el trabajo. El tamaño de la muestra (228 pacientes) se calculó con la fórmula de promedios para población infinita con nivel de confianza del 95 por ciento. La técnica muestral fue por cuota empleando como marco muestral el listado de pacientes con incapacidad temporal para el trabajo y diagnóstico de lumbalgia mecánica. Las variables estudiadas fueron las características sociodemográficas, el perfil de uso, costo unitario y costo promedio de los servicios otorgados. El análisis estadístico incluyó porcentajes, promedios, intervalo de confianza y proyección. Resultados: El costo total promedio por paciente con lumbalgia mecánica es de 1744,08 USD, la incapacidad es el costo más elevado (1083,71 USD), seguido de los estudios de gabinete (394,89 USD), las consultas (180,52 USD), los medicamentos y el laboratorio. Conclusión: El costo institucional del paciente con incapacidad temporal para el trabajo con lumbalgia mecánica resulta en miles de dólares y, proyectado a una población de pacientes, el costo se incrementa a millones.

Background: Back pain affects frequently to the economically active people. It is the first cause of business day loss in workers aged 55 or less, and the second cause of absenteeism. Objective: To determine the institutional cost of the patient with temporary inability to work, due to low back pain. Methods: Costs design records of patients <55 years old, with temporary inability to work were analyzed. The sample size (228 patients) was calculated with the average formula for infinite people, with confidence interval of 95%. The sample technique was by quota, using the listing of patients with temporary inability to work and mechanical low back pain, as framework. Variables used were socio-demographic characteristics, unit cost and average cost of services provided. Statistical analysis included percentages, means, confidence interval and projection. Results: Total average cost of the patient with mechanical low back pain is about 1,744.08 USD, the inability represents the highest average cost (1,083.71 USD), followed by cabinet studies (394.89 USD), appointments (180.52 USD), medications and laboratory. Conclusion: The institutional cost of the patient with inability to work secondary to low back pain is high and the cost increases to millions in a population of patients.

Costo institucional del paciente con incapacidad temporal para el trabajo por lumbalgia mecánica / Institutional cost of the patient with temporary inability to work due to mechanical low back pain

Introducción: La lumbalgia afecta de manera frecuente a la población económicamente activa. Es la primera causa de pérdida de días laborales en trabajadores menores de 55 años de edad y la segunda de ausentismo laboral. Objetivo: Determinar el costo institucional del paciente con incapacidad temporal para el trabajo por lumbalgia mecánica. Materiales y métodos: Se realizó un estudio de costos de expedientes de trabajadores con lumbalgia de 20 a 60 años con incapacidad temporal para el trabajo. El tamaño de la muestra (228 pacientes) se calculó con la fórmula de promedios para población infinita con nivel de confianza del 95 por ciento. La técnica muestral fue por cuota empleando como marco muestral el listado de pacientes con incapacidad temporal para el trabajo y diagnóstico de lumbalgia mecánica. Las variables estudiadas fueron las características sociodemográficas, el perfil de uso, costo unitario y costo promedio de los servicios otorgados. El análisis estadístico incluyó porcentajes, promedios, intervalo de confianza y proyección. Resultados: El costo total promedio por paciente con lumbalgia mecánica es de 1744,08 USD, la incapacidad es el costo más elevado (1083,71 USD), seguido de los estudios de gabinete (394,89 USD), las consultas (180,52 USD), los medicamentos y el laboratorio. Conclusión: El costo institucional del paciente con incapacidad temporal para el trabajo con lumbalgia mecánica resulta en miles de dólares y, proyectado a una población de pacientes, el costo se incrementa a millones.(AU)

Background: Back pain affects frequently to the economically active people. It is the first cause of business day loss in workers aged 55 or less, and the second cause of absenteeism. Objective: To determine the institutional cost of the patient with temporary inability to work, due to low back pain. Methods: Costs design records of patients <55 years old, with temporary inability to work were analyzed. The sample size (228 patients) was calculated with the average formula for infinite people, with confidence interval of 95%. The sample technique was by quota, using the listing of patients with temporary inability to work and mechanical low back pain, as framework. Variables used were socio-demographic characteristics, unit cost and average cost of services provided. Statistical analysis included percentages, means, confidence interval and projection. Results: Total average cost of the patient with mechanical low back pain is about 1,744.08 USD, the inability represents the highest average cost (1,083.71 USD), followed by cabinet studies (394.89 USD), appointments (180.52 USD), medications and laboratory. Conclusion: The institutional cost of the patient with inability to work secondary to low back pain is high and the cost increases to millions in a population of patients.(AU)