Medical Costs For Back And Neck Problems Are Rising, But Health Outcomes Are Not Improving

The amount of money people spend to treat their back and neck problems
has increased substantially in the last decade. Despite this, their
health status does not seem to be comparably improving, according to a
study in the February 13 issue of JAMA.



In clinical practice, back and neck problems are some of the most
commonly experienced symptoms. In 2002, a survey of adults in the
United states showed 26 percent reporting lower back pain and 14
percent reporting neck pain in the three months previous, according to
the background information in the article. Imaging and therapy rates
for back and neck/spine problems have increased considerably in the
last decade, but it is not clear how this has affected expenditures or
health outcomes for patients with these problems.



In this article, Brook I. Martin, M.P.H., of the University of
Washington, Seattle, and colleagues conducted a study to analyze just
this. They used data from the nationally representative Medical
Expenditure Panel Survey (MEPS) from 1997-2005. Of the total of 23,045
U.S. Adults over the age of 17 who responded in 1997, 3,139 reported
spine problems. In 2005, of total 22,258 respondents, 3,187 reported
spine problems.



Those with spine problems had higher expenditures than those without,
according to the researchers. After adjusting for age, sex, and
inflation, the average expenditure of a patients with spine problems in
1997 was $4,695, in contrast with $2,731 for those without. In 2005,
the average for those with spine problems was $6,096, while those
without spent an average of just $3,516. From 1997 to 2005, this shows
an estimated 65 percent inflation-adjusted increase in total
expenditure of adults with spine problems. This is a more rapid
increase than overall health expenditures.



Many of the differences observed in these inflation-adjusted
expenditures between those with and without spine problems in 2005
could be attributed to outpatients services (36%) and inpatients
services (28 percent.) To a lesser extent, prescription medications (23
percent), emergency department visits (3 percent) and home health,
dental, and other expenses (10 percent) accounted for the discrepancy.



Physical functioning limitations reported by persons with back or neck
problems increased from an estimated 20.7 percent to 24.7 percent from
1997 to 2005. Accordingly, self-reported measures of mental health,
physical functioning, limitations at work or in school, and limitations
in social settings among adults with spine problems were worsened from
1997 to 2005.



The authors conclude that spine problems are a significant contribution
to medical costs without direct improvements in the health outcomes.
"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."




Expenditures and Health Status Among Adults With Back and Neck
Problems

Brook I. Martin, Richard A. Deyo, MD, MPH, Sohail K. Mirza, Judith A.
Turner, Bryan A. Comstock, William Hollingworth, Sean D. Sullivan

JAMA, February 13, 2008-Vol 299, No. 6

jama.ama-assn



Written by Anna Sophia McKenney