Predictive factors of high societal costs among chronic low back pain patients

Abstract

Background: Societal costs of low back pain (LBP) are high, yet few studies have been performed to identify the predictive factors of high societal costs among chronic LBP patients. This study aimed to determine which factors predict high societal costs in patients with chronic LBP. Methods: Data of 6,316 chronic LBP patients were used. In the main analysis, high societal costs were defined as patients in the top 10% of cost outcomes. Sensitivity analyses were conducted using patients in the top 5% and top 20% of societal costs.Potential predictive factors included patient expectations, demographic factors (e.g. age, gender, nationality), socio-economic factors (e.g. employment, education level) and health-related factors (e.g. body mass index [BMI], general health, mental health). The final prediction models were obtained using backward selection. The model's prognostic accuracy (Hosmer-Lemeshow X 2 , Nagelkerke's R 2 ) and discriminative ability (area under the receiver operating curve [AUC]) were assessed, and the models were internally validated using bootstrapping. Results: Poor physical health, high functional disability, low health-related quality of life, high impact of pain experience, non-Dutch nationality and decreasing pain were found to be predictive of high societal costs in all models, and were therefore considered robust. After internal validation, the models' fit was good, their explained variance was relatively low (≤14.1%) and their AUCs could be interpreted as moderate (≥0.71). Conclusion: Future studies should focus on understanding the mechanisms associated with the identified predictors for high societal costs in order to design effective cost reduction initiatives. Significance: Identifying low back pain patients who are at risk (risk stratification) of becoming high-cost users and making appropriate initiatives could help in reducing high costs. |MUTUBUKI eT al.

Low back pain

“…25 Approximately two-thirds of the economic costs from low back pain stem from indirect costs (eg, loss of productivity). 26 Mutubuki and colleagues 27 found that female sex, young age, multiple causes, poor quality of life, and high disability (ie, functional impairment) were predictive of high societal costs (eg, health care or diminished productivity) among patients with chronic low back pain. 27 Another study showed that expenditures from presenteeism (ie, being present at work with suboptimal performance) were higher than direct medical costs.…”

“…26 Mutubuki and colleagues 27 found that female sex, young age, multiple causes, poor quality of life, and high disability (ie, functional impairment) were predictive of high societal costs (eg, health care or diminished productivity) among patients with chronic low back pain. 27 Another study showed that expenditures from presenteeism (ie, being present at work with suboptimal performance) were higher than direct medical costs. 28 The nature of low back pain could also result in less quantifiable costs such as difficulties doing domestic chores, caregiving, engaging in recreational activities, struggles with relationships, depression, and anxiety.…”

A Study of the Effects of the COVID-19 Pandemic on the Experience of Back Pain Reported on Twitter® in the United States: A Natural Language Processing Approach

“…Back pain is one of the most common chronic disorders, which not only can reduce work productivity and negatively affect the quality of life [ 12 ], but can also increase the economic and societal burden [ 13 ]. Furthermore, it is reported that individuals with chronic back pain are worried about losing their jobs and they tend to continue to work without disclosure of pain to their employers [ 14 ].…”

“…Because of that, in many cases the back pain will not be properly managed. It is reported that for almost 62% of patients with back pain, the pain comes back after one year [ 13 ]. The economic burden of back pain is estimated to be between 1% to 2% of the gross national product in Western nations [ 16 ].…”

The effect of exercise programs on pain management and motor control in patients with nonspecific chronic low back pain: A randomized matched subjects trial

“…[ 3 ] In addition to social and disabling burden of back pain, its economic burden is considerable. [ 4 ]…”