Abstract
Purpose
This review aims to explore the methodologies used for estimating the direct and indirect costs attributed to back pain in developed countries.
Methods
Six databases were searched to uncover studies about the direct and indirect costs of back pain published in English upto November 2016. Data extracted included study characteristics, cost categories and analysis methods. Results were synthesised descriptively.
Results
The search identified 8009 potential studies, of which 40 were included for data extraction. The included studies reported data from 14 industrialised countries with considerably varying methodologies. Most of the studies (n=25) followed a retrospective study design and cost perspective was largely societal (n=26). Nearly half of the selected studies included indirect costs in their analysis as well as direct costs; and the proportion of indirect costs in most of the studies far outweighed the direct costs (3:1 ratio). The analysis method used most frequently was the top-down approach (n=13) followed by bottom-up approach (n=7) and econometric methods (n=7). Inpatient costs and absenteeism costs were the most important cost drivers accounting for 12%−35% of the direct costs and 5%−67% of the indirect costs respectively. The healthcare costs associated with back pain in the UK were estimated at £1.6 billion in 1998 while the indirect costs ranged from £5 billion to £10.7 billion.
Conclusions
This is the first methodological systematic review assessing the costs of back pain. Despite differences in methodology, the economic burden of back pain is significant. Development of guideline and standardisation of methodologies is needed for future studies.
Conflict of interest: None
Sources of funding: None
