Janssen Global Services LLC , Raritan, NJ 08869 , USA.
J Med Econ. 2012;15(2):245-52. doi: 10.3111/13696998.2011.642090. Epub 2011 Dec 5.
BACKGROUND: This research addresses the need for population-based studies on the burden of chronic low back pain (CLBP) by examining healthcare service use and costs for patients with and without neuropathic components in the US population. METHODS: Data were analyzed from PharMetrics IMS LifeLink™ US Claims Database (2006-2008). Patients (≥18 years) with 36 months continuous enrollment, ICD-9 code for low back pain, and claims in 3 out of 4 consecutive months in the 12-month prospective period were included and classified with CLBP. Patients were further classified with a neuropathic component (wNP) and without a neuropathic component (woNP) based on ICD-9 codes. Healthcare resources, physical therapy, prescription medication use, and associated costs were assessed for the period January 1-December 31, 2008. RESULTS: A number of patients (39,425) were identified with CLBP (90.4% wNP). Patients wNP included more women, were older and more likely to have clinically diagnosed depression, and made significantly greater use of any prescription medication at index event, opioids (particularly schedule II), and healthcare resources. Total direct costs of CLBP-related resource use were ∼US$96 million over a 12-month follow-up. CLBP wNP accounted for 96% of total costs and mean annual cost of care/patient was ∼160% higher than CLBP patients woNP (US$ 2577 vs US$ 1007, p < 0.0001). LIMITATIONS: This study was descriptive and was not designed to demonstrate causality between diagnosis, treatment, and outcomes. Resource use and costs for reasons other than LBP were not included. Patients with neuropathic pain are more likely to seek treatment; therefore CLBP patients with a non-neuropathic component may be under-represented. CONCLUSIONS: The disproportionately high share of interventional resource use in CLBP wNP suggests greater need for new treatment options that more comprehensively manage the range of pain symptoms and signaling mechanisms involved, to help improve patient outcomes and reduce the burden on healthcare systems.
背景：本研究通过考察美国人群中伴有和不伴有神经病理性成分的慢性腰痛（CLBP）患者的医疗服务利用情况和成本，解决了基于人群的慢性腰痛负担研究的需求。
方法：本研究数据来自 PharMetrics IMS LifeLink™美国索赔数据库（2006-2008 年）。纳入研究的患者为年龄≥18 岁，在 36 个月的连续入组期间，有 ICD-9 编码的腰痛，且在 12 个月前瞻性期间的 4 个月连续期间内有 3 个月的索赔记录，被分类为 CLBP 患者。根据 ICD-9 编码，患者进一步被分类为伴有神经病理性成分（wNP）和不伴有神经病理性成分（woNP）。在 2008 年 1 月 1 日至 12 月 31 日期间，评估了医疗资源、物理治疗、处方药物使用情况以及相关费用。
结果：共确定了 39425 例 CLBP（90.4% wNP）患者。wNP 患者中女性更多，年龄更大，且更有可能患有临床诊断的抑郁症，在指数事件时，更广泛地使用了任何处方药物、阿片类药物（特别是 II 类）和医疗资源。在 12 个月的随访期间，CLBP 相关资源使用的直接总成本约为 9600 万美元。CLBP wNP 占总成本的 96%，且每位患者的年平均护理费用比 CLBP woNP 患者高 160%（2577 美元 vs 1007 美元，p<0.0001）。
局限性：本研究为描述性研究，不能证明诊断、治疗和结局之间存在因果关系。未包括除腰痛以外的其他原因引起的资源使用和费用。患有神经病理性疼痛的患者更有可能寻求治疗，因此，不伴有神经病理性成分的 CLBP 患者可能代表性不足。
结论：CLBP wNP 患者大量使用介入性资源，表明更需要新的治疗方法，以更全面地管理所涉及的各种疼痛症状和信号机制，从而帮助改善患者结局，并减轻医疗系统的负担。
Spine (Phila Pa 1976). 2012-5-15
Curr Med Res Opin. 2010-4
J Med Econ. 2011-10-12
Glob Adv Integr Med Health. 2025-2-21
Zotero 插件