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Incremental health care costs for chronic pain in Ontario, Canada

a population-based matched cohort study of adolescents and adults using administrative data

Hogan, Mary-Ellen; Taddio, Anna; Katz, Joel; Shah, Vibhuti; Krahn, Murray

doi: 10.1097/j.pain.0000000000000561
Research Paper

Little is known about the economic burden of chronic pain and how chronic pain affects health care utilization. We aimed to estimate the annual per-person incremental medical cost and health care utilization for chronic pain in the Ontario population from the perspective of the public payer. We performed a retrospective cohort study using Ontario health care databases and the electronically linked Canadian Community Health Survey (CCHS) from 2000 to 2011. We identified subjects aged ≥12 years from the CCHS with chronic pain and closely matched them to individuals without pain using propensity score matching methods. We used linked data to determine mean 1-year per-person health care costs and utilization for each group and mean incremental cost for chronic pain. All costs are reported in 2014 Canadian dollars. After matching, we had 19,138 pairs of CCHS respondents with and without chronic pain. The average age was 55 years (SD = 18) and 61% were female. The incremental cost to manage chronic pain was $1742 per person (95% confidence interval [CI], $1488-$2020), 51% more than the control group. The largest contributor to the incremental cost was hospitalization ($514; 95% CI, $364-$683). Incremental costs were the highest in those with severe pain ($3960; 95% CI, $3186-$4680) and in those with most activity limitation ($4365; 95% CI, $3631-$5147). The per-person cost to manage chronic pain is substantial and more than 50% higher than a comparable patient without chronic pain. Costs are higher in people with more severe pain and activity limitations.

The annual per-person direct medical cost for a patient with chronic pain was more than 50% higher than a comparable patient without chronic pain.

aGraduate Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada

bLeslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada

cChild Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada

dDepartment of Psychology, York University, Toronto, ON, Canada

eDepartment of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

fToronto Health Economics and Technology Assessment (THETA) Collaborative, Faculty of Medicine and Pharmacy, University of Toronto, Toronto, ON, Canada

gInstitute for Clinical Evaluative Sciences, Toronto, ON, Canada

Corresponding author. Address: Leslie Dan Faculty of Pharmacy, Room 658, 144 College St, Toronto, ON M5S 3M2, Canada. Tel.: 416-9476-3718; fax: 416-946-3719. E-mail address: (M.-E. Hogan).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received December 02, 2015

Received in revised form February 22, 2016

Accepted March 09, 2016

© 2016 International Association for the Study of Pain
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