This article was originally published here
EClinicalMedicine. December 24, 2021; 43: 101247. doi: 10.1016 / j.eclinm.2021.101247. eCollection 2022 Jan.
BACKGROUND: Low back pain (LBP) is the most common diagnosis responsible for sick leave, long-term disability benefits, and early retirement. Studies have suggested that the relatively low proportion of patients referred to a specialist for treatment, whether conservative or surgical, accounts for most of the total back pain costs. However, a complete and long-term picture of the socio-economic burden associated with these two treatment regimens is lacking.
Methods: From a cohort encompassing the entire Danish population (5.8 million inhabitants), we identified patients with low back pain referred to specialized treatment, conservative or surgical, during the period 2007 -2016. According to the treatment modality, two different cohorts were constructed. Each patient was matched to ten controls from the baseline population based on age, sex, region of residence, and period of treatment (month and year). Using large nationwide registry data, health care costs and lost productivity from two years before the first intervention through 2018 were studied.
RESULTS: A total of 56,694 patients underwent surgical treatment and 72,915 patients conservative treatment. Both cohorts had a significantly higher baseline cost two years prior to treatment compared to baseline population controls. These measurements increased sharply during the year following treatment. Five years after treatment, healthcare costs and loss of productivity remained proportionately increased in a similar fashion for both treatment groups compared to the base population. The multiple surgeries had detrimental effects on the long-term productivity of the patients, and the spouses of the patients had slightly increased the loss of productivity.
INTERPRETATION: The results show that the patients referred for specialized treatment of low back pain have a poor socio-economic prognosis, regardless of the conservative or surgical treatment modality. This development was reinforced in patients undergoing multiple surgeries and was also observed in the spouses of patients. Our results of substantial loss of productivity in the subgroups indicate that measures of treatment success need to be more nuanced.