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Costs rising for back, neck problems without evidence of improved outcomes
From 1997 to 2005, total national expenditures increased an estimated 65% for adults with spine problems — more rapid than overall health expenditures.
Although expenses related to back and neck problems have increased substantially during the last decade, outcomes such as functional disability and work limitations do not appear to be improving, according to a study published in the Journal of the American Medical Association.
"These data suggest that spine problems are expensive, due both to large numbers of affected persons and to high costs per person. We did not observe improvements in health outcomes commensurate with the increasing costs over time. Spine problems may offer opportunities to reduce expenditures without associated worsening of clinical outcomes," the authors said in the study.
Brook I. Martin, MPH, of the University of Washington, Seattle, and colleagues examined changes in expenditures and health status related to spine problems from 1997 to 2005. The researchers analyzed data from the nationally representative Medical Expenditure Panel Survey (MEPS).
The MEPS included data for 23,045 respondents — U.S. adults aged older than 17 years — who were sampled in 1997, including 3,139 respondents who reported spine problems. In 2005, the sample included 22,258 respondents, including 3,187 who reported spine problems, according to the study.
The researchers found that persons who reported spine problems had higher expenditures in each year compared to those without such problems.
In 1997, age- and gender-adjusted medical costs for respondents with spine problems averaged $4,695 compared with $2,731 for respondents without spine problems.
In 2005, age- and gender-adjusted medical expenditures among respondents with spine problems averaged $6,096, compared with $3,516 among respondents without spine problems, according to the study.
All cost estimates were inflation-adjusted to 2005 dollars, the study authors noted.
From 1997 to 2005, these trends resulted in an estimated 65% inflation-adjusted increase in the total national expenditure of adults with spine problems, a more rapid increase than overall health expenditures, the authors reported.
Outpatient services accounted for 36% of the difference observed in inflation-adjusted expenditures between those patients with and without spine problems in 2005, and inpatient services accounted for 28%, according to the study.
Prescription medications accounted for 23% of the difference observed in expenditures, while emergency department visits accounted for 3% and home health, dental and other expenses accounted for 10%.
The estimated proportion of respondents with back or neck problems who self-reported physical functioning limitations also increased, from 20.7% in 1997 to 24.7% in 2005. In addition, adjusted self-reported measures of mental health, physical functioning, work or school limitations and social limitations among adults with spine problems were worse in 2005 than in 1997, according to the study.
For more information:
- Martin BI, Deyo RA, Mirza SK, et al. Expenditures and health status among adults with back and neck problems. JAMA. 2008;299:656-664.