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Economic Impact of Back Pain Substantial

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Duke Health News 919-660-1306

DURHAM, N.C. -- In one of the largest analyses of its kind,
a team of Duke University Medical Center researchers has found
that patients suffering from back pain consume more that $90
billion annually in health-care expenses, with approximately
$26 billion of that amount directly attributable to treating
the back pain.

The researchers said that their results not only demonstrate
the enormous economic impact of back pain, but provide concrete
data that policy makers and researchers can use in determining
how health-care resources should be allocated.

The Duke team mined data from the Medical Expenditure Panel
Survey (MEPS) in 1998. The MEPS is a national survey conducted
by the Agency of Healthcare Research and Quality (AHRQ) and the
National Center for Health Statistics. The team found that 25.9
million adults reported back pain in 1998, with 172.7 million
reporting no back pain.

"To put these expenses in perspective, the total $90 billion
spent in 1998 represented 1 percent of the U.S. Gross Domestic
Product (GDP), and the $26 billion in direct back pain costs
accounted for 2.5 percent of all health care expenditures for
that year," said lead researcher Xuemei Luo, Ph.D., who
published the results of the Duke study today (Jan. 1, 2004) in
the journal Spine.

"We believe that the results of our analysis highlight the
prevalence of back pain in the U.S. and its impact on the
health-care system," Luo continued. "Not only are the costs
enormous, but they vary widely across patients with different
clinical, socioeconomic and demographic backgrounds.
Significant health-care savings could be achieved if this
population of patients received more cost-effective and
targeted treatments."

For the purposes of their study, back pain was defined as
pain experienced in any portion of the back, whether it be
caused by back disorders, disc disorders or injuries to the
back at some point during 1998.

The population of 25.9 Americans adults who reported back
pain tended to be female (55 percent), white (88.3 percent),
and married (61 percent), with an average age of 48.

In their analysis, the researchers looked at such cost
categories as in-hospital costs, office-based visits, hospital
outpatient visits, emergency room visits, prescription
medications and home health services. For office-based and
outpatient services, in addition to physician visits, the
survey also measured visits to such health-care providers as
chiropractors, physical therapists, psychologists and
nurses.

The annual per capita expenditures for patients with back
pain were 1.6 times higher than those without back pain --
$3,498 vs. $2,177. These increased expenditures were found in
all categories:

-- Inpatient charges: $1,075 vs. $774
-- Office visits: $910 vs. $425
-- Prescription drugs: $541 vs. $340
-- Outpatient care: $460 vs. $248
-- Home health $105 vs. $92
-- Emergency room: $102 vs. $61

"We found that health-care expenditures were not equally
distributed among patients with different levels of
expenditures," Luo explained. "For example, in each of the
health services, the top 10 percent most expensive patients
accounted for more than half of the total expenditures.
Furthermore, the 25 percent most expensive patients accounted
for more than 75 percent of the total expenditures."

As would be expected, the researchers found that elderly
patients with back pain incurred higher expenditures compared
to younger patients.

"We also found that females incurred higher average
expenditures than males," Luo said. "The reason for this
difference is not clear and needs further investigation.

"Also, the fact that white patients as well as patients who
had medical insurance had higher per capita expenses suggests
that there may be some barriers to care for those who are
African-American or uninsured," Luo said.

However, when compared to those with private insurance,
patients who had government-supported insurance had higher
expenditures, especially in the areas of inpatient care, home
health services and prescription drugs.

"Since these two groups are insured, it would be interesting
to investigate whether the difference in the expenditures is
caused by the differences in the insurance programs," Luo
said.

Luo's research was supported by Duke's Center for Clinical
Effectiveness, part of the department of surgery.

Other members of the team were, from Duke, Ricardo
Pietrobon, M.D., and Lloyd Hey, M.D. Other team members
included Shawn Sun, Ph.D., and Gordon Liu, Ph.D., of the
University of North Carolina, Chapel Hill.

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