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Direct and indirect costs in persons with chronic back pain and comorbid mental disorders--a systematic review
Harald Baumeister1, Annika Knecht, Nico Hutter
1Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Germany. baumeister@psychologie.uni-freiburg.de
Insights
Chronic back pain patients with mental disorders incur higher direct healthcare costs. However, evidence for increased indirect costs, like productivity losses, remains inconclusive, necessitating further research for resource allocation.
Area of Science:
- Health Economics
- Psychiatry
- Pain Management
Background:
- Chronic back pain (CBP) is a significant health concern associated with substantial economic burden.
- Comorbid mental disorders in CBP patients may exacerbate healthcare costs and productivity losses.
- Understanding these cost implications is crucial for effective healthcare policy and resource allocation.
Purpose of the Study:
- To systematically review and compare direct and indirect costs in CBP patients with and without mental disorders.
- To examine the hypothesis that mental disorders increase healthcare utilization and productivity losses in CBP patients.
Main Methods:
- A comprehensive literature search was conducted across multiple databases (Medline, EMBASE, PsycINFO, Psyndex, EconLit, IBSS).
- Studies comparing direct and indirect costs between CBP patients with and without mental disorders were included.
- Meta-analysis was performed for specific cost outcomes where data allowed.
Main Results:
- Ten studies met the inclusion criteria, comparing costs in CBP patients with and without mental disorders.
- Increased direct healthcare costs were observed in CBP patients with depression, including higher primary care, specialty care, and radiologic procedure utilization.
- Mental health visits were significantly higher in CBP patients with depression. Increased surgery incidence was noted in CBP patients with PTSD. Indirect cost findings regarding return to work and work absence were inconsistent.
Conclusions:
- CBP patients with mental disorders exhibit increased direct healthcare costs, but evidence for elevated indirect costs is limited and inconsistent.
- The current evidence base is constrained by a low number of studies per outcome, highlighting the need for more research.
- Accurate cost data is essential for informed healthcare policy decisions, especially given limited healthcare resources.
Objective:
Direct inpatient and outpatient healthcare costs as well as indirect costs (e.g. productivity losses) are hypothesized to be increased in chronic back pain (CBP) patients with mental disorders. The aim of this systematic review is to examine this hypothesis by comparing costs in CBP patients with and without mental disorders.
Methods:
A comprehensive literature search (Medline, EMBASE, PsycINFO, Psyndex, EconLit, IBSS) was conducted. All studies were included which allowed for a comparison of direct and indirect costs between CBP patients with and without mental disorders.
Results:
Of 2283 potentially relevant articles, 10 studies fulfilled the inclusion criteria. Total healthcare costs (SMD=0.16 [SE=0.06]; n=1), CBP-related healthcare costs (SMD=0.21 [0.06]; n=1), CBP-related primary care visits (OR=1.6 [95%-CI:1.2-2.3]; n=1), CBP-related specialty care visits (OR=1.4 [1.0-2.0];n=1), CBP-related radiologic procedures (OR=1.6 [1.0-2.5]; n=1) and mental health visits (OR=8.1 [7.3-9.1]; n=2) were increased in CBP patients with depression. The incidence of new surgeries was increased in CBP patients with PTSD (OR=4.2 [1.6-10.8]; n=1). Pain-related healthcare use (n=1) in CBP patients with both depression and anxiety and CBP-related hospital admissions (n=1) in CBP patients with depression were not increased. Regarding indirect costs results were inconsistent for both return to work rates (n=3) and work absence (n=2).
Conclusion:
The results indicate increased direct but not indirect costs in CBP patients with mental disorders. However, the evidence is limited due to the low number of studies per outcome. This is all the more problematic, since the adequate allocation of healthcare resources will become a major topic of health care policy due to limited resources.
