Costing Methodology and Key Drivers of Health Care Costs Within Economic Analyses in Musculoskeletal Community and Primary Care Services: A Systematic Review of the Literature

Abstract

Background: Identifying variation in musculoskeletal service costs requires the use of specific standardized metrics. There has been a large focus on costing, efficiency, and standardized metrics within the acute musculoskeletal setting, but far less attention in primary care and community settings. Objectives: To ( a) assess the quality of costing methods used within musculoskeletal economic analyses based primarily in primary and community settings and ( b) identify which cost variables are the key drivers of musculoskeletal health care costs within these settings. Methods: Medline, AMED, EMBASE, CINAHL, HMIC, BNI, and HBE electronic databases were searched for eligible studies. Two reviewers independently extracted data and assessed quality of costing methods using an established checklist. Results: Twenty-two studies met the review inclusion criteria. The majority of studies demonstrated moderate- to high-quality costing methods. Costing issues included studies failing to fully justify the economic perspective, and not distinguishing between short- and long-run costs. Highest unit costs were hospital admissions, outpatient visits, and imaging. Highest mean utilization were the following: general practitioner (GP) visits, outpatient visits, and physiotherapy visits. Highest mean costs per patient were GP visits, outpatient visits, and physiotherapy visits. Conclusion: This review identified a number of key resource use variables that are driving musculoskeletal health care costs in the community/primary care setting. High utilization of these resources (rather than high unit cost) appears to be the predominant factor increasing mean health care costs. There is, however, need for greater detail with capturing these key cost drivers, to further improve the accuracy of costing information.

Unintended consequences: quantifying the benefits, iatrogenic harms and downstream cascade costs of musculoskeletal MRI in UK primary care

“…While MRI spending is a low proportion of MSK system costs, 93 cascades alter the economic analysis. Cascade costs were significantly greater than direct-imaging costs.…”

Benchmarking community/primary care musculoskeletal services: A narrative review and recommendation

“…In order to evaluate costs and use of healthcare resources across MSK pathways of care and emerging models of practice, routine collection and reporting of key MSK cost drivers is needed. A systematic review of key MSK cost drivers in 2020 (Burgess et al., 2020) found that GP visits, outpatient visits, and physiotherapy visits were by far the highest mean costs across included economic analyses, followed by prescription medications and hospital admissions. These five cost drivers alone captured over 70% of the costs in the majority of included studies and could provide a feasible method for estimating costs in MSK services and across a pathway of MSK care.…”

“…Measuring health service performance involves collecting data in a number of key areas (Hibbert et al, 2020), including: effectiveness and appropriateness of care (for example effectiveness of an intraarticular joint injection measured using PROMs; or appropriateness of a lumbar spine MRI measured against set standards such as NICE Guidelines (NICE, 2016)); safety of care (for example providing information/advice such as safety netting patients for serious spinal pathology); efficiency of services (for example capturing number of healthcare visits for treatment of an MSK condition to a GP, Physiotherapist, or Secondary Care specialist (Burgess et al, 2020); and patient experience (for example use of tools such as the Friends and Family Test (FFT) (NHS England, 2019England, , 2020 to ensure that patients are satisfied with the care received, and have been appropriately involved in decision-making about their care (e.g. using the Collab-oRATE tool (Elwyn et al, 2013)).…”

Minimal clinical datasets for spine-related musculoskeletal disorders in primary and outpatient care settings: a scoping review

“…Musculoskeletal (MSK) disorders are a major problem of the global burden of disease [1,2] and are associated with decreased general physical [3] and mental health [4], high healthcare utilization, and costs [5]. Specifically, neck and low back pain accounted for 88 million years lived with disability in 2019 [1].…”