Back, neck pain: no improvement in outcomes despite rising medical costs

Although expenses related to back and neck problems have increased substantially in the last decade, outcomes such as functional disability and work limitations do not appear to be improving, according to a study in the February 13 issue of JAMA.

Brook I. Martin, MPH, of the University of Washington, Seattle, and colleagues conducted a study to examine changes in expenditures and health status related to spine problems. The researchers analyzed data on more than 23,000 people from 1997-2005.

The researchers found that expenditures were higher in each year for those with spine problems than for those without. In 1997, the average adjusted medical costs for respondents with spine problems was $4,695, compared with $2,731 among those without spine problems (inflation adjusted to 2005 dollars). In 2005, those costs rose to $6,096, compared with $3,516. These trends resulted in an estimated 65 percent inflation-adjusted increase in the total national expenditure of adults with spine problems, a more rapid increase than overall health expenditures.

Most of the difference was accounted for by outpatient services (36 percent), inpatient services (28 percent) and medications (23 percent). The estimated proportion of persons with back or neck problems who self-reported physical functioning limitations increased from 20.7 percent to 24.7 percent from 1997 to 2005. Adjusted self-reported measures of mental health, physical functioning, work or school limitations, and social limitations among adults with spine problems were worse in 2005 than in 1997.

"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," the authors concluded.