ReviewDirect and indirect costs in persons with chronic back pain and comorbid mental disorders—A systematic review
Introduction
Prevalence rates of chronic back pain (CBP) in the general population are estimated to be 5.9% to 11.1% [1]. CBP poses a large economic burden for the healthcare system [2]. For example, direct healthcare costs of low back pain were estimated to be £1632 million in the UK in 1998. Costs of informal care and productivity losses related to low back pain totalled approximately £10668 million [3]. Annual direct costs of CBP were reported to be higher than €7000 per person in Germany [1]. Indirect costs such as work absenteeism represents a majority of overall costs associated with CBP [1], [2].
Systematic reviews on costs in patients with other medical diseases than CBP reported substantially increased direct and indirect costs in medically ill patients with comorbid mental disorders [4], [5], [6]. Persons with CBP are at increased risk for comorbid mental disorders [7], [8]. While mental disorders in CBP have consistently been linked with impaired quality of life [9], [10], greater disability [11], [12], [13], increased risk of chronicity [14] and decreased pain self-management such as reduced exercise duration [15], the existing evidence regarding costs in CBP and comorbid mental disorders is ambiguous. Hence, the present systematic review aims to aggregate data on the association between mental disorders and direct and indirect costs in CBP patients. The following research questions will be addressed:
- 1)
To what extent are comorbid mental disorders in CBP patients associated with increased costs in comparison to CBP patients without mental comorbidity?
- 2)
Are there differences in this association with regard to specific comorbid mental disorders?
Section snippets
Method
The data collection for this study was part of the project “Meta-analysis of quality of life and healthcare costs in somatically ill patients with comorbid mental disorders”, funded by the Landesstiftung Baden-Württemberg [4], [5], [6], [10].
Results
The database search yielded 2283 potentially relevant articles, which were evaluated in a preliminary sensitive selection process by one reviewer (see Fig. 1). Then, two reviewers independently selected relevant studies from a set of 873 abstracts or full papers. Finally, 10 primary studies fulfilled inclusion criteria [11], [20], [21], [22], [23], [24], [25], [26], [27], [28]. For one potentially relevant dissertation abstract, no full text could be located [19].
Discussion
Some evidence was found for increased direct healthcare costs but not indirect costs in CBP patients with mental disorders compared to CBP patients without mental disorders. Self-evidently, increased direct costs were particularly pronounced with regard to mental healthcare costs, but not limited to these mental health specific costs. Of eight studies, six reported slightly to moderately increased total and back pain-related overall, inpatient and outpatient costs underlining a significant
Conclusion
Similar to other diseases [4], [5], [6] the results of the available studies point in the direction of increased direct healthcare costs in CBP patients with comorbid mental disorders. However, as yet, the (only modest) evidence indicates that mental disorders in CBP are not as highly associated with incremental healthcare costs as in other medical diseases. Since the adequate allocation of healthcare resources will become a major topic in the future due to evermore limited resources, these
Competing interest statement
The authors have no competing interests to report.
Acknowledgments
We would like to thank the Landesstiftung Baden-Württemberg for funding the research project.
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