Healthcare utilization and related costs among older people seeking primary care due to back pain: findings from the BACE-N cohort study

Munk Killingmo, Rikke; Storheim, Kjersti; Van Der Windt, Danielle; Zolic-Karlsson, Zinajda; Nesse Vigdal, Ørjan; Kretz, Lise; Cvancarova Småstuen, Milada; Grotle, Margreth

Abstract

OBJECTIVES: To describe healthcare utilization and estimate associated costs during 1?year of follow-up among older people seeking primary care due to a new episode back pain and to describe healthcare utilization across patients with different risk profiles stratified using the StarT Back Screening Tool (SBST). DESIGN: Prospective cohort study. PARTICIPANTS AND SETTING: A total of 452 people aged =55 years seeking Norwegian primary care with a new episode of back pain were included. OUTCOME MEASURES: The primary outcome of this study was total cost of healthcare utilization aggregated for 1?year of follow-up. Secondary outcomes included components of healthcare utilization aggregated for 1?year of follow-up. Healthcare utilization was self-reported and included: primary care consultations, medications, examinations, hospitalisation, rehabilitation stay, and operations. Costs were estimated based on unit costs collected from national pricelists. Healthcare utilization across patients with different SBST risk profiles was compared using Kruskal-Wallis test, post hoc Mann-Whitney U tests and Bonferroni adjustment. RESULTS: In total, 438 patients were included in the analysis. Mean (BCa 95%?CI) total cost per patient over 1?year was €825 (682-976). Median (BCa 95%?CI) total cost was €364 (307-440). The largest cost category was primary care consultations, accounting for 56% of total costs. Imaging rate was 34%. The most commonly used medication was paracetamol (27%-35% of patients). Medium- and high-risk patients had a significantly higher degree of healthcare utilization compared with low-risk patients (p<0.030). CONCLUSION: This study estimated a 1?year mean and median cost of healthcare utilization of €825 and €364, respectively. Patients within the top 25th percentile accounted for 77% of all costs. Patients classified as medium risk and high risk had a significantly higher degree of healthcare utilization compared with patients classified as low risk. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT04261309, results.

Citation

Munk Killingmo, R., Storheim, K., Van Der Windt, D., Zolic-Karlsson, Z., Nesse Vigdal, Ø., Kretz, L., …Grotle, M. (2022). Healthcare utilization and related costs among older people seeking primary care due to back pain: findings from the BACE-N cohort study. BMJ Open, 12(6), Article ARTN e057778. https://doi.org/10.1136/bmjopen-2021-057778

• Journal Article Type: Article
• Acceptance Date: May 15, 2022
• Online Publication Date: Jun 20, 2022
• Publication Date: Jun 20, 2022
• Publicly Available Date: May 30, 2023
• Journal: BMJ Open
• Electronic ISSN: 2044-6055
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 12
• Issue: 6
• Article Number: ARTN e057778
• DOI: https://doi.org/10.1136/bmjopen-2021-057778
• Keywords: back pain; primary care; BACE-N
• Publisher URL: https://bmjopen.bmj.com/content/12/6/e057778.info