Direct and indirect costs in persons with chronic back pain and comorbid mental disorders—A systematic review
Journal of Psychosomatic Research, 06/20/2012
Evidence Based Medicine
Baumeister H et al. – The results indicate increased direct but not indirect costs in chronic back pain (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.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.
- 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).