Direct and indirect costs of managing patients with musculoskeletal pain—challenge for health care

Abstract

Musculoskeletal pain is an outstanding symptom among the patients of primary health care. However, there are few studies of management and costs of musculoskeletal pain at primary health care level. The aim of this study was to describe the diagnostic investigations, management, referral rate and sick leaves related to visits prompted by musculoskeletal pain as well as to assess their costs. A total of 28 general practitioners (GPs) at 25 randomly selected health centres throughout Finland collected the data for this 4 week study, which covered 1 week from each of the four seasons. All visits, except those occurring after hours, were recorded. Altogether 1123 patients visited GPs because of musculoskeletal pain. Laboratory tests were ordered for 12% and imaging investigations for 24%. A total of 16% of the patients suffering from musculoskeletal pain received a prescription for physiotherapy, and analgesics were prescribed to 61% of them. Physicians referred 7% of the pain patients to specialist care. One out of every four patients was prescribed sick leave. The mean cost of the investigations, therapy, referrals, and sick leaves was as high as 530 EUR per visit, with absenteeism from work constituting two-fifths of the total costs. Musculoskeletal pain is not just a frequent complaint but also has extensive economic consequences for society. Investigations and therapy at the primary health care level play a minor role in the costs as compared with specialist care and sick leaves.

Impact of multiple joint problems on daily living tasks in people in the community over age fifty‐five

“…Recent data suggest that the cost associated with musculoskeletal pain has extensive economic consequences for the community (3,35), and with target estimates of the global burden of musculoskeletal conditions (36) increasing with the aging population, it is essential that appropriate strategies be addressed. Our data suggest that urgent changes need to be made in the understanding and management of joint problems and that a holistic approach to patient care is required.…”

“…Individuals reporting such pain represent a considerable direct and indirect cost to health care services (3,4) and are more likely to have poorer general health (5) and greater levels of depression (6), anxiety (7), physical disability (2,8), and associated lost productivity in the workforce (9,10). Although there is some limited recognition that the presentation of multiple joint problems is common (2), the focus of management strategies is still aimed at individual joint problems: indeed, the functional impact on daily tasks of the most common multiple joint combinations has not been explored.…”

The Canadian STOP-PAIN project – Part 2: What is the cost of pain for patients on waitlists of multidisciplinary pain treatment facilities?

“…4,[6][7][8][9] Rates of health service utilization have been determined, [6][7][8]10 but the economic consequences remain unknown because studies have reported rates rather than costs. In the studies that have reported public costs associated with chronic pain, 8,[11][12][13][14] some components of the costs were not included. None of the studies that measured time lost from employment captured the time that patients and family caregivers devoted to receiving and providing care and time they lost from leisure and household work.…”

Rehabilitation Benefits Highly Motivated Patients: A Six-Year Prospective Cost-Effectiveness Study

“…Most of the medical measures took place within primary care. More evidence is needed from primary care about the management of musculoskeletal disorders, because this treatment level largely determines the total costs in the long-term perspective (20).…”