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Costs Associated With Treatment of Chronic Low Back Pain: An Analysis of the UK General Practice Research Database

Hong, Jihyung PhD*,†; Reed, Catherine PhD; Novick, Diego MD; Happich, Michael PhD

doi: 10.1097/BRS.0b013e318276450f
Health Services Research

Study Design. Retrospective cohort study of health care costs associated with the treatment of chronic low back pain (CLBP) in the United Kingdom.

Objective. To assess 12-month health care costs associated with the treatment of CLBP, using the UK General Practice Research Database.

Summary of Background Data. CLBP is a common health problem.

Methods. Data were obtained from the General Practice Research Database, a computerized database of UK primary care patient data. Patients with CLBP were identified for the study period (January 1, 2007, to December 31, 2009) using diagnostic records and pain relief prescriptions (n = 64,167), and 1:1 matched to patients without CLBP (n = 52,986) on the basis of age, sex, and general practitioner's practice. Index date was defined as the first date of CLBP record; the same index date was assigned to matched controls. Multivariate analyses were performed to compare resource use costs (2009 values) in the 12 months after the index date between patients with and without CLBP. A sensitivity analysis was carried out with a more stringent definition for the control group by excluding a broad range of pain conditions.

Results. Total health care costs for patients with CLBP were double those of the matched controls (£1074 vs. £516; P < 0.05). Of the cost difference, 58.8% was accounted for by general practitioner's consultations, 22.3% by referrals to secondary care, and the rest by pain relief medications. The sensitivity analysis revealed an even greater cost difference between the 2 groups (£1052 vs. £304; P < 0.05). Because of the use of a retrospective administrative claims database, this study is subject to selection bias between study cohorts, misidentification of comorbidities, and an inability to confirm adherence to therapy or assess indirect costs and costs of over-the-counter medications.

Conclusion. Our findings confirm the substantial economic burden of CLBP, even with direct costs only.

A retrospective cohort study of 12-month health care costs of chronic low back pain (CLBP), using the UK General Practice Research Database. Total health care costs for CLBP were double those of matched controls (P < 0.05), confirming the substantial economic burden of CLBP, even with direct costs only.

*Personal Social Services Research Unit, London School of Economics and Political Science, London, United Kingdom

Global Health Outcomes, Eli Lilly and Company, Windlesham, Surrey, United Kingdom; and

Eli Lilly and Company, Bad Homburg, Germany.

Address correspondence and reprint requests to Jihyung Hong, PhD, Personal Social Services Research Unit, London School of Economics, Houghton St., London, UK, WC2A 2AE; E-mail: j.hong@lse.ac.uk

Acknowledgment date: March 14, 2012. First revision date: August 5, 2012. Acceptance date: September 24, 2012.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Eli Lilly and Company funds were received to support this work.

Relevant financial activities outside the submitted work: consultancy and stock/stock options.

© 2013 Lippincott Williams & Wilkins, Inc.