Costs and consequences of chronic pain due to musculoskeletal disorders from a health system perspective in Chile

Abstract

Background: Chronic pain is a prevalent and distressing condition caused by an unceasing pain lasting more than 3 months or a pain that persists beyond the normal healing time. There is evidence of inadequate management partly explained by the unawareness regarding the magnitude of the problem.

Objectives: To estimate the annual expected costs and consequences of chronic pain caused by musculoskeletal diseases from the health system perspective in Chile.

Methods: A Markov cohort model was built to represent chronic pain and estimate expected costs and consequences over 1-year time horizon. Transition probabilities were obtained through expert elicitation. Consequences examined were: years lost to disability (YLD), depression, anxiety, and productivity losses. Direct health care costs were estimated using local sources. Probabilistic sensitivity analysis was performed to characterize second-order uncertainty.

Results: The annual expected cost due to musculoskeletal chronic pain was estimated in USD $1387.2 million, equivalent to 0.417% of the national GDP. Lower back pain and osteoarthritis of the knee explained the larger proportion of the total cost, 31.8% and 27.1%, respectively. Depression attributed to chronic pain is another important consequence accounting for USD $94 million (Bayesian credibility interval 95% $49.1-$156.26). Productivity losses were also important cost, although early retirement and presenteeism were not measured. Chronic pain causes 137,037 YLDs.

Conclusion: Chronic pain is not only an important cause of disability but also responsible for high social and financial burden in Chile. Public health programs focused on managing chronic pain may decrease burden of disease and possibly reduce costs.

Keywords: Chile; Chronic pain; Cost; Economic evaluation.

Figure 1.

Markov model to represent chronic pain. The figure represents the natural history of chronic pain where patients transit through a 4-state Markov model. The 4 health states that make up the model are based on the intensity of pain: mild, moderate, severe, and death from other causes. Patient's transit through the model irrespective of the pathology of origin based on the transition probabilities obtained through an expert elicitation exercise.

Figure 2.

Schematic representation of costs and consequences of chronic pain. The figure represents the structure of this cost–consequence study. It identifies the cost components as well as the health and nonhealth consequences of chronic pain because of MSK disorders. MSK, musculoskeletal; OA, osteoarthritis; YLD, year lived with disability.