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Increased Expenditures for Other Health Conditions After an Incident of Low Back Pain

Nimgade, Ashok, MD*; McNeely, Eileen, PhD*; Milton, Donald, MD, DrPH*; Celona, Joseph, MD

doi: 10.1097/BRS.0b013e3181c06a89
Health Services Research

Study Design. We reviewed healthcare expenditures in a random sample of 655 patients from a managed health plan with new onset low back pain (LBP) in 1999.

Objective. To understand the affect of LBP on health care utilization for other health conditions.

Summary of Background Data. Researchers often consider individual diseases in isolation rather than seeking a more comprehensive picture of comorbid conditions and their collective influence. Although underlying health conditions may exacerbate LBP, as has been discussed extensively, minimal attention has been given to the potential affect of LBP on other conditions.

Methods. We compared the healthcare expenses using 30-, 60-, and 90-day back care time windows before and after the initial LBP visit. Diagnostic (International Classification of Diseases, Ninth Revision) and treatment codes (Current Procedural Terminology [CPT]) were used to identify the expenditures for LBP and other conditions.

Results. Average monthly expenses per patient for other health conditions increased after LBP initiation when compared with the prior 1 to 3 months. This increase persisted even after the following conservative adjustments: (a) excluding all radiology expenses that occurred coincident with LBP; (b) excluding billings for non-LBP conditions that occurred on days of any LBP visit because these charges may have reflected mere convenience “shopping or servicing” behavior; (c) excluding patients with a baseline of low healthcare utilization before LBP initiation because convenience may have been especially important for this cohort. Patients with greater non-LBP expenses were likelier to have been prescribed psychiatric medications.

Conclusion. LBP episodes were associated with increased expenditures for other health conditions. This suggests that the traditional estimates of LBP based primarily on LBP services underestimate the true cost of the condition. Further research may help to delineate the role of LBP, along with physical or mental comorbidities in boosting non-LBP costs.

A database study of a community-based managed care organization showed average monthly expenses per patient for non-low back pain (LBP) diagnoses increasing after LBP initiation. This spillover effect persisted even after adjusting for possible confounders. Mental stressors may be involved, since patients with higher spillover non-LBP expenses were likelier to have been on psychiatric medications.

From the *Environmental and Occupational Medicine, Harvard School of Public Health, Boston, MA; and †Fallon Clinic Inc., Worcester, MA.

Acknowledgment date: February 13, 2008. Revision date: October 29, 2008. Acceptance date: July 13, 2009.

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

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Ashok Nimgade, MD, Environmental and Occupational Medicine, Harvard School of Public Health, Boston, MA 02446; E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.