Studies Evaluating Costs Due to Lower Back Pain Vary Widely From Country to Country
Low back pain (LBP) is an increasingly prevalent disorder in the developed world. The cost of LBP is growing but there are no consistent measures to qualify and quantify the actual cost resulting from LBP.

The total economic cost is made up of issues that affect the LBP and its treatment alone, not costs associated with any other illness or disorder. These costs include direct costs, which include actual payment for services or products. Many of the costs are obvious, such as paying for doctor visits, medical devices, and medications, but many other costs are not often considered. These types of cost include the cost of transportation to attend appointments, meals to be eaten while at appointments, and renovations to living accommodations, to name a few.

Indirect costs are commonly thought of as lost wages or lost productivity (cost to the employer), as well as productivity loss at home and the cost of hiring help in the home. The third are the intangible costs, which are the value of the decreased enjoyment of life, for example.

The authors of this article reviewed several studies done over the past few years and found 27 relevant studies examining the costs of LBP. The studies were from Australia, Belgium, the Isle of Jersey, Japan, Korea, the Netherlands, Sweden, the United Kingdom, and United States. The studies were done in varying fashions, with varying approaches, making direct comparisons difficult. Another aspect that cannot be ignored in comparing studies are the delays between data collection and study publication. The authors use the example that two studies published at the same time could be reporting data from either 2 years earlier or as many as 11 years earlier. This would affect the cost totals considerably.

Despite all the differences, the common thread was the important economic burden of LBP, regardless of geography. That being said, the case definition of LBP did vary between studies. As well, the type of help sought by patients with LBP affected direct costs. For example, in the US, patients were more likely to seek out the assistance of a chiropractor than were patients in the UK (31 percent compared with 2 percent). Also challenging was the separation of treatment and cost between LBP and other health issues that patients may have that were unrelated to LBP.

In conclusion, the authors write that regardless of the many differences in the studies, a common thread that would decrease costs related to LBP was an early return to work by the patients. This, however, may be easier said than done as this involves cooperation between the patient, employers, clinicians, and third party payers. Further studies are needed in the US in order to determine actual costs.
Simon Dagenais, DC, PhD, Jaime Caro, MD, and Scott Haldeman, DC, MD, PhD. A systemic review of low back pain cost of illness studies in the United States and internationally. In The Spine Journal. January/February 2008. Vol. 8. Issue 1. Pp. 8-20