Abstract
BackgroundSocietal 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.MethodsData 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.ResultsPoor 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).ConclusionFuture studies should focus on understanding the mechanisms associated with the identified predictors for high societal costs in order to design effective cost reduction initiatives.SignificanceIdentifying 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.
Highlights
Low back pain (LBP) has become the leading cause of years lived with disability in high, middle‐ and low‐ income countries (Vos et al, 2017) A 54% increase in years lived with disability caused by low back pain (LBP) was reported worldwide between 1990 and 2015 (Hartvigsen, Hancock, & Kongsted, 2018) Next to the high disease burden of LBP, its economic burden is substantial (Tulder, Koes, & Bombardier, 2002) In 2007, for example, the societal cost of LBP in the Netherlands was estimated to be 3.5 billion euros, which accounted for approximately 0.6% of the Gross National Product (Lambeek et al, 2011)
A systematic review by Hestbaek, Leboeuf‐Yde, and Manniche (2003) showed that in many cases LBP did not resolve on its own and that 62% of LBP patients keep experiencing pain after 12 months.(Hestbaek et al, 2003; Verkerk et al, 2013) the majority of LBP patients do not seek treatment (Ferreira et al, 2010) and Engel, Von Korff, and Katon (1996) and Vlaeyen et al (2018) reported that it is very likely that the majority of the total societal costs from LBP stem from a relatively small group of chronic LBP patients (Engel et al, 1996; Vlaeyen et al, 2018)
Previous studies have reported an increase in LBP intensity to be a predictor of high costs (Becker et al, 2010; Wenig et al, 2009), the present study reported decreasing pain intensity as a predictor of high costs
Summary
Low back pain (LBP) has become the leading cause of years lived with disability in high‐, middle‐ and low‐ income countries (Vos et al, 2017) A 54% increase in years lived with disability caused by LBP was reported worldwide between 1990 and 2015 (Hartvigsen, Hancock, & Kongsted, 2018) Next to the high disease burden of LBP, its economic burden is substantial (Tulder, Koes, & Bombardier, 2002) In 2007, for example, the societal cost of LBP in the Netherlands was estimated to be 3.5 billion euros, which accounted for approximately 0.6% of the Gross National Product (Lambeek et al, 2011). Identifying factors predictive of high societal costs may provide opportunities to create appropriate initiatives aiming to prevent high‐cost outcomes as well as result in improvement of patient quality of life and a reduction in health care spending (Buchbinder et al, 2013; Chechulin, Nazerian, Rais, & Malikov, 2014). This study aimed to determine which factors predict high societal costs in patients with chronic LBP. 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 considered robust. 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
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