What Is the Total Cost of Low Back Pain?

Abillion here, a billion there, and pretty soon you're talking about real money," quipped U.S. Senator Everett Dirksen.

Nowhere is this observation more relevant that in the study of low back pain-and its costs. Everyone acknowledges that low back pain is enormously expensive but there is substantial disagreement about its total costs-and discord about how to estimate them accurately.

Simon Dagenais, DC, PhD, and colleagues recently performed a systematic review of low back pain cost-of-illness studies published from 1997 to 2007. They found 21 relevant investigations. (See Dagenais et al., 2008.) These employed a variety of different methods and arrived at substantially different conclusions. "Estimates of the economic costs in different countries vary greatly depending on study methodology but by any standards they must be considered a substantial burden on society," these researchers observed.

Dagenais and colleagues could not find any studies that accurately estimated the total costs of low back pain in the United States. And they noted that it won't be possible to come up with cost-effective solutions in the management of low back pain without these data. "Cost of illness studies summarizing the economic burden of a particular disease must be considered by all stakeholders, including patients, clinicians, and third-party payers, when deciding on the allocation of scarce healthcare resources," they pointed out.

Those seeking to develop miracle cures for low back pain need to look well beyond the clinic in gauging the impact of new treatments and management strategies. "From studies conducted outside the United States, it appears that direct medical costs represent only a small proportion of the total costs of low back pain..." according to Dagenais et al. Indirect costs from work absence, long-term disability claims, and lost productivity account for the lion's share of back pain's economic burden. And the prevention of long-term disability is likely to be the most important goal in reducing the economic burden of low back pain.

Reference: Dagenais S et al., A systematic review of low back pain costs of illness studies in the United States and internationally, The Spine Journal, 2008; 8:8-20.