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Low Back Pain in Primary Care: Costs of Care and Prediction of Future Health Care Utilization

Becker, Annette MD, MPH*; Held, Heiko MD*; Redaelli, Marcus MD; Strauch, Konstantin PhD; Chenot, Jean F. MD, MPH§; Leonhardt, Corinna PhD; Keller, Stefan PhD; Baum, Erika MD, PhD*; Pfingsten, Michael PhD**; Hildebrandt, Jan MD, PhD**; Basler, Heinz-Dieter PhD; Kochen, Michael M. MD, MPH, PhD, FRCGP§; Donner-Banzhoff, Norbert MD, MHSc, PhD*

doi: 10.1097/BRS.0b013e3181cd656f
Health Services Research

Study Design. Cost of illness study alongside a randomized controlled trial.

Objective. To describe the costs of care for patients with low back pain (1) and to identify patient characteristics as predictors for high health care cost during a 1-year follow-up (2).

Summary of Background Data. Low back pain (LBP) is one of the leading causes of high health care costs in industrialized countries (Life time prevalence, 70%). A lot of research has been done to improve primary health care and patients′ prognosis. However, the cost of health care does not necessarily follow changes in patient outcomes.

Methods. General practitioners (n = 126) recruited 1378 patients consulting for LBP. Sociodemographic data, pain characteristics, and LBP-related cost data were collected by interview at baseline and after 6 and 12 months. Costs were evaluated from the societal perspective. Predictors of high cost during the subsequent year were studied using logistic regression analysis.

Results. Mean direct and indirect costs for LBP care are about twice as high for patients with chronic LBP compared to acutely ill patients. Indirect costs account for more than 52% to 54% of total costs. About 25% of direct costs refer to therapeutic procedures and hospital or rehabilitational care. Patients with high disability and limitations in daily living show a 2- to 5-fold change for subsequent high health care costs. Depression seems to be highly relevant for direct health care utilization.

Conclusion. Interventions designed to reduce high health care costs for LBP should focus on patients with severe LBP and depressive comorbidity. Our results add to the economic understanding of LBP care and may give guidance for future actions on health care improvement and cost reduction.

We performed a cost-of-illness study alongside a randomized controlled trial. Mean costs for chronic low back pain are almost twice as high as for acute pain. Disease severity and depression are the most important predictors of high direct and indirect costs during a 1-year follow-up.

From the *Department of General Practice, Preventive, and Rehabilitation Medicine, University of Marburg, Marburg, Germany; †Institute of General Practice and Family Medicine, Private University Witten/Herdecke gGmbH, Witten, Germany; ‡Institute of Medical Biometry and Epidemiology, University of Marburg, Marburg, Germany; §Department of General Practice, University of Göttingen, Göttingen, Germany; ¶Institute of Medical Psychology, University of Marburg, Marburg, Germany; ∥Department of Public Health Sciences, University of Hawaii at Manoa, Honolulu, HI; and **Department of Anaesthesiology, Pain Clinic, University of Göttingen, Göttingen, Germany.

Acknowledgment date: October 30, 2008. Revision date: September 23, 2009. Acceptance date: September 28, 2009.

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

Fedral 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.

Supported by the German Ministry for Education and Research (BMBF, FKZ 01 EM 0113).

The study was approved by the institutional review boards of the Göttingen university and Marburg university, Germany.

Address correspondence and reprint requests to Annette Becker, MD, MPH, Department of General Practice, Preventive, and Rehabilitation Medicine, University of Marburg, Karl-von-Frisch-Str. 4, 35032 Marburg, Germany; E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.