The cost of lower back pain in the USA in terms of
healthcare dollars - surgical vs non surgical
Lost time from work
Dollars to workman's comp and the dollar cost to the legal system

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Request for Question Clarification by pafalafa-ga on 01 Feb 2003 08:54 PST

I've got some pretty detailed data, but not in the precise categories
you ask for (and nothing on legal costs -- I doubt that information
exists).

What I do have access to are costs associated with visits to the
doctors office, outpatient and inpatient costs, medicines, home care,
emergency room visits, work related vs non-work related costs, numbers
of people experiencing back pain, etc.  The data aren't specific to
*lower* back pain, but include all types of back pain.

If this type of data will suit your needs, let me know, and I'll post
it as an answer.

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Clarification of Question by tony12345-ga on 01 Feb 2003 18:01 PST

Hi thanks for the efforts so far, unfortunately needed most of the
data I had requested, I will take the data you have so far, but would
really appreciate it if you could add the following data

total annual cost of workmans comp claims

number of days lost at work through lower back pain

Hello Tony.

As one who has had lifelong problems with a bad back (happily, now
under control as long as I get to the gym on a regular basis),
answering this question became a personal challenge.  I've compiled a
great deal of data and I'll summarize the key points here.  Copyright
restrictions prevent me from providing too much verbatim information
from the reports below, but I've given links for each, and would
encourage you to check out the details of each report yourself.

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Direct Costs of Back Pain in the United States:  A National Estimate
Marko A. Mychaskiw, R.Ph., Ph.D. and Joseph Thomas III, Ph.D.

http://www.ispor.org/congresses/ne1102/present_pdf/poster/PNP5.pdf


"Almost 9 percent or 23 million individuals experienced back pain,
approximately 1.5 percent or 4 million individuals experienced
work-related back pain, and approximately 2 percent or 5 million
individuals experienced missed workdays back pain."

                                Numbers of      Percent 95% confidence
limit
                                people          
Aggregate back pain 		23,495,886 	8.74 	8.24 to 9.24
Work-related back pain 		4,075,263 	1.52 	1.31 to 1.72
Missed workdays back pain 	4,736,232 	1.76 	1.54 to 1.98

"Direct costs of aggregate or total back pain were almost $15 billion,
direct costs of work-related back pain were approximately $2.7
billion, and direct costs of missed workdays back pain were
approximately $5.4 billion"

The authors break the total costs out this way:

Type of Service 		Total Cost 							
Prescription medications 	$941,406,990 	
Inpatient visits 		$4,658,655,867 	
Emergency room visits 		$557,825,229 	
Outpatient department visits 	$2,050,207,342 	
Office-based provider visits 	$5,768,302,826 	
Home health visits 		$725,019,395 	

and work-related only costs this way:

Prescription medications 	$278,664,764 	
Inpatient visits 		$452,246,728 	
Emergency room visits 		$105,422,556 	
Outpatient department visits 	$392,249,665 	
Office-based provider visits 	$1,360,216,083 	
Home health visits 		$54,850,851 	

Their main conclusion is this:

"Direct costs of occupationally related back pain were substantially
lower, $2.7 billion, than total direct costs, $14.7 billion. This
suggests that the majority of back injuries that prompt seeking
medical care occur outside of the workplace."

The paper is chock full of other details.  

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A summary of a study: 

Back Pain Prevalence in US Industry and Estimates of Lost Workdays
Guo HR, Tanoko S, Halerin WE, Cameron LL 
Am J Public Health. 1999;89:1029-1035.

can be found here:

http://www.injuryfree.com/research/research_topics_backpain.htm

"According to the authors, back pain is the most frequent cause of
workers' compensation claims, representing about 23% of all claims and
about 33% of compensation costs. This condition accounts for 49% of
all sick time usage, second only to the common cold. In 1990, back
pain in the United States was estimated to cost between $30 billion
and $100 billion. The purpose of this study was to identify and rank
industries according to the prevalence of workdays lost due to back
pain."

Again, there is a wealth of detail here, such as the fact that the
construction industry reported the largest number of work related
cases of back pain.

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Back pain statistics (some a bit dated) reviewed here:

Cost of Musculoskeletal Injuries on the Job
http://www.chiroweb.com/archives/12/25/23.html

report the following:

"Low back pain alone accounts for 16 percent of all workers'
compensation claims but 33 percent of all WC costs. According to
recent studies the mean cost per case for low back injuries is $8,321
(1989). In 1986 the costs were $6,807 per case (a 123 percent increase
in only three years). Total expenditures for back pain in the US are
estimated to be in excess of $50 billion annually."

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Finally, at the site for the National Institute for Occupational
Safety and Health there is this immensely detailed study of "Worker
Health by
Industry and Occupation" including, of course, back problems:

http://www.cdc.gov/niosh/pdfs/2001-120.pdf

"There were 312,994 cases of musculoskeletal disor-
ders of the back reported, having a rate of
37.25/10,000 workers and a median of five DAFW" 
[NOTE: days away from work].

"Table 13 shows back conditions according to industry
by number of cases, rate, and DAFW. Rates range
from a low of 1.22/10,000 for the passenger trans-
portation arrangement industry to a high of
213.68/10,000 for the scheduled air transportation
industry. Nursing and personal care facilities and hos-
pitals have the most cases, with 25,525 and 24,534,
respectively."

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I hope this gives you most, if not all the information you need. 
There are many, many ways to "cut" the data, and I've presented here
just the ones that seemed most relevant to your needs.  Please don't
hesitate to post a "Request for Clarification" if you would like any
additional information.

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Clarification of Answer by pafalafa-ga on 02 Feb 2003 06:07 PST

I found another reference worth knowing about:

Indirect Cost of Episodic and Chronic-Episodic Health Conditions in
the United States: Results from the American Productivity Audit
Ricci JA, Stewart WF, Chee E, Morganstein D

at:  http://www.ispor.org/meetings/va0502/presentations/sesion1/PHP25.pdf

I compares costs (dollars and lost time) of back pain to other
ailments such as colds and flu, and includes breakdowns by gender. 
Most of the data is presented in graphical (rather than table) format,
so have a look.

Hope this is helpful.

Well done, we did not get to the bottom of everything we were looking
for, but got enough to make the exercise a excellent investment of
time.

Many thanks, now the 3rd time I have used this service and has come up
trumps everytime, well done and thanks