Identifying the Economic Burden of Pain

San Diego—Pain is challenging to treat and the healthcare cost burden of pain is substantial. According to researchers, understanding the dynamics of the economic burden of pain will help providers and payers allocate resources more efficiently for improved management of various pain conditions.

Researchers recently conducted a retrospective claims study to track the annual healthcare resource utilization (HCRU) associated with 36 chronic and 14 acute pain conditions. Resources tracked included inpatient, outpatient, and emergency department visits, as well as pain-related medications. The researchers reported study results during a poster session at the AMCP meeting. The poster was titled Economic Burden of Pain in a National Health Insurance Plan.

The researchers utilized enrollment, medical, and pharmacy claims data for Humana’s fully insured commercial members and Medicare beneficiaries. Eligible subjects were identified using a pain condition with an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code in the primary diagnosis position on the medical claim during the index period July 1, 2008, through September 30, 2011. For chronic conditions, a second diagnosis ≥90 days from the initial diagnosis was required.

HCRU and costs were estimated for the pain conditions per member and informed unadjusted cost models. All analyses were stratified by membership in commercial or Medicare plans.

The study cohort included 267,948 members from the commercial plan; 51% (n=137,166) had a chronic pain condition and 49% (n=130,792) had an acute pain condition. Also included in the analyses were 596,616 members from the Medicare population (72% [n=430,299] with noncancer chronic pain and 28% [n=166,317] with a noncancer acute pain condition).

In the commercial population, the most prevalent chronic pain condition was back pain, followed by osteoarthritis (OA). In the Medicare population, the most prevalent chronic pain condition was OA, followed by back pain.

Among patients in the commercial population, injuries were the most common acute pain condition; among those in the Medicare population, injuries were the most common acute pain condition, followed by nonhip/nonspine fractures.

Women were slightly more likely to have chronic pain in both populations. In the commercial population, men were more likely to have an acute pain condition, whereas in the Medicare population, women were more likely to be diagnosed with acute pain. Overall, those with acute pain were slightly older compared with those with chronic pain and most of the beneficiaries resided in the South (a reflection of the Humana member population).

The most expensive conditions among the commercial population were back pain (adjusted annual plan-wide costs, $119 million), osteoarthritis ($98 million), childbirth ($69 million), injuries ($61 million), and nonhip/nonspine fractures ($48 million). The most expensive pain-related conditions per commercial member were burns reclassified as chronic (adjusted cost per member, $140,524), spinal cord injuries ($77,093), and repeated spine fractures ($25,931).

Among the Medicare population, the most expensive conditions for the plan were osteoarthritis ($327 million), back pain ($218 million), hip fractures ($117 million), injuries ($82 million), and nonhip/nonspine fractures ($67 million). The most expensive pain-related conditions per member were burns ($27,234), repeated hip fractures ($21,058), and acute hip fractures ($12,336).

In conclusion, the researchers stated, “This research is suggestive of the importance of effective pain management. The conditions that ranked most expensive are those with multiple etiologies and numerous treatment options, and are therefore those that present healthcare providers with challenges around prevention and care. Determining the cause of pain will enable earlier treatment, which may reduce preventable healthcare utilization costs.”