Die Last der chronischen Rückenschmerzen - mehr Komorbidität und höhere Kosten

Abstract

Study Design. Retrospective analysis of an insurance claims database.Objective. To examine the comorbidities, treatment patterns, healthcare resource utilization and direct medical costs of patients with chronic low back pain (CLBP) in clinical practice.Summary of Background Data. Although the socioeconomic impact of CLBP is substantial, characterization of comorbidities, pain-related pharmacotherapy, and healthcare resource use/costs of CLBP patients relative to non-CLBP controls have been infrequently documented.Methods. Using the LifeLink Health Plan Claims Database, CLBP patients, defined using the International Classification of Diseases (Ninth Revision, Clinical Modification) were identified and matched (age, gender, and region) with non-CLBP individuals. Comorbidities, pain-related pharmacotherapy, and healthcare service use/costs (pharmacy, outpatient, inpatient, total) were compared for the two groups during 2008.Results. A total of 101,294 CLBP patients and controls were identified (55% female; mean age was 47.2±11.6 years). Relative to controls, CLBP patients had a greater comorbidity burden including a significantly higher (P<0.0001) frequency of musculoskeletal and neuropathic pain conditions, and common sequelae of pain such as depression (13.0% versus 6.1%), anxiety (8.0% versus 3.4%), and sleep disorders (10.0% versus 3.4%). Pain-related pharmacotherapy was significantly greater (P < 0.0001) among CLBP patients including opioids (37.0% versus 14.8%; P < 0.0001), NSAIDs (26.2% versus 9.6%; P<0.0001), and tramadol (8.2% versus 1.2%; P < 0.0001). Prescribing of "adjunctive" medications for treating conditions associated with pain (i.e. depression, anxiety, and insomnia) was also significantly greater (P < 0.0001) among CLBP patients; 36.3% of patients received combination therapy. Healthcare costs were significantly higher in the CLBP cohort (P < 0.0001), reflecting greater resource utilization. Total direct medical costs were estimated at $8,386±$17,507 in the CLBP group and $3,607±$10,845 in the control group; P < 0.0001).Conclusion. Patients with CLBP are characterized by greater comorbidity and economic burdens relative to those without CLBP. This economic burden can be attributed to greater prescribing of pain-related medications and increased health resource utilization.