Abstract
Low back pain (LBP) is one of the most common musculoskeletal disorders worldwide and a frequent cause for health care utilization with a high economic burden. A large proportion of diagnostic imaging in patients with LBP is inappropriate and can cause more harm than good, which in turn can lead to higher health care costs. The aim of this study was to determine characteristics and health care costs for patients with a diagnostic imaging for LBP in Switzerland. Groupe Mutuel, one of the biggest health care insurance companies in Switzerland and covering approximately 12% of the population, provided data for this analysis. Patients were identified by diagnostic imaging for the lumbar spine in 2016 or 2017. The study period was 2015–2019, that is one year before and two years after the year of imaging. Regression analysis models were used to identify patient variables associated with higher health care costs. A total of 75,296 patients (57% female, mean age: 54.5 years) were included into the study. Magnetic resonance imaging was the most commonly used diagnostic method (44.3%). Patients generated annual mean health care costs of 518,488,470 CHF (466,639,621 Euro) in the whole observation period; 640 million CHF (576 million Euro) in the index year. Overall, costs for LBP patients were 72% higher compared with the costs of no LBP patients. Our findings confirm the economic burden of LBP and highlight the importance of ongoing efforts to improve prevention, diagnostics and patient care in patients with LBP.
Highlights
Acute non-specific low back pain (LBP) is one of the most common musculoskeletal disorders worldwide [1,2,3]
A detailed table of comorbidity frequencies overall and by diagnostic imaging is provided in Table S2, Supplementary Information
For patients with only one comorbidity matched with no LBP patients, we found a heterogeneous distribution of costs ranging from 868 CHF (781 EUR) for cardiovascular diseases up to 35,465 CHF (31,918 EUR) for cancer, Supplementary Information, Table S4
Summary
Acute non-specific low back pain (LBP) is one of the most common musculoskeletal disorders worldwide [1,2,3]. Despite the individual burden of affected patients, health care costs of LBP are of particular interest and various studies using quite different methodological approaches report estimates of costs of patients with LBP [6]. Even if not always necessary in many acute LBP cases, radiological imaging is a common part of the patient workup [10]. The images themselves cause health care costs and incidental findings, requiring further investigations, generate further health care costs. This is one reason, why various guidelines promoting good clinical practice are available [10] and the recommendation of avoiding unnecessary radiological imaging is one of the most prominent messages of both international and national choosing wisely campaigns [11, 12]. A range of further comorbidities like depression, anxiety or sleep
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