Saturday, September 29, 2018 9:00 am–10:00 am A Fresh Look at Opioids: 267. Burden of illness associated with low back pain: healthcare resource utilization and direct cost

Abstract

BACKGROUND CONTEXT Low back pain (LBP) has a costly economic and societal burden, especially when considering the costs related to disability and loss of work productivity (indirect costs), as well as nonsurgical and surgical interventions (direct costs), such as lumbar fusion. PURPOSE We sought to determine the 3 years health care utilization and direct costs of patients with LBP diagnosis, with stratification based on the occurrence of lumbar fusion surgery. We hypothesized that the economic burden of LBP patients is significant and medical resource utilization and costs are greater for LBP patients who undergo 1-2 level lumbar fusion. STUDY DESIGN/SETTING Retrospective cohort analysis. PATIENT SAMPLE A total of 852,111 LBP patients, of which 10,224 received one or two level spinal fusions within 3 years following the LBP diagnosis. OUTCOME MEASURES Utilization and costs of medical resources and outpatient analgesic medications in a 3-year period. METHODS A claims database of privately-insured patients from October 2011 to September 2016 was used to evaluate medical and outpatient analgesic medication claims associated with LBP. The utilization and costs were compared between the LBP patients with and without 1- or 2-level spinal fusion. RESULTS The cohort of 852,111 LBP patients accrued $4.23 billion ($497 million per 100,000 persons) in direct health care costs over 3 years. The most commonly used medical resources were physician office visits (90.5%), hospital outpatient encounters (42.1%) and spine x-rays (41.9%). However, in terms of costs, the largest contributors were hospital inpatient costs (32.5%), physician office costs (23.5%), and hospital outpatient costs (20.8%). 69.1% of LBP patients filled analgesic medication prescriptions with opiate agonists being the most frequent (42.3%), followed by NSAIDs (36.7%), and anti-depressants (25.3%). Patients who received one- or two-level spinal fusions used medical resources and filled outpatient analgesic medication prescriptions more frequently and had higher direct costs (average $69,204 vs. $4,186, p CONCLUSIONS The cost of managing LBP is substantial, both for those who receive spinal fusions and for non-fusion patients. The 3-year direct economic burden for LBP patients with fusions was estimated to be $707.5 million (equivalent to $6.9 billion per 100,000 fusion patients). Including indirect cost estimates, the 3-year societal burden in this cohort of non-fusion LBP patients was estimated to range from $8,372 to $28,883 per patient (equivalent to $837 million to $2.9 billion per 100,000 LBP patients). FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.