Avalon Health Solutions, Inc., Philadelphia, PA 19102, USA.
Spine (Phila Pa 1976). 2012 May 15;37(11):E668-77. doi: 10.1097/BRS.0b013e318241e5de.
STUDY DESIGN: Retrospective analysis of an insurance claims database. OBJECTIVE: To examine the comorbidities, treatment patterns, health care resource utilization, and direct medical costs of patients with chronic low back pain (CLBP) in clinical practice. SUMMARY OF BACKGROUND DATA: Although the socioeconomic impact of CLBP is substantial, characterization of comorbidities, pain-related pharmacotherapy, and health care resource use/costs of patients with CLBP relative to non-CLBP controls have been infrequently documented. METHODS: Using the LifeLink Health Plan Claims Database (IMS Health Inc., Watertown, MA), patients with CLBP, defined using the International Classification of Diseases, Ninth Revision, Clinical Modification, were identified and matched (age, sex, and region) with non-CLBP individuals. Comorbidities, pain-related pharmacotherapy, and health care service use/costs (pharmacy, outpatient, inpatient, total) were compared for the 2 groups during 2008. RESULTS: A total of 101,294 patients with CLBP and controls were identified (55% women; mean age was 47.2 ± 11.6 years). Relative to controls, patients with CLBP had a greater comorbidity burden including a significantly higher (P < 0.0001) frequency of musculoskeletal and neuropathic pain conditions and common sequelae of pain such as depression (13.0% vs. 6.1%), anxiety (8.0% vs. 3.4%), and sleep disorders (10.0% vs. 3.4%). Pain-related pharmacotherapy was significantly greater (P < 0.0001) among patients with CLBP including opioids (37.0% vs. 14.8%; P < 0.0001), nonsteroidal anti-inflammatory drugs (26.2% vs. 9.6%; P < 0.0001), and tramadol (8.2% vs. 1.2%; P < 0.0001). Prescribing of "adjunctive" medications for treating conditions associated with pain (i.e., depression, anxiety, and insomnia) was also significantly greater (P < 0.0001) among patients with CLBP; 36.3% of patients received combination therapy. Health care costs were significantly higher in the CLBP cohort (P < 0.0001), reflecting greater resource utilization. Total direct medical costs were estimated at $8386 ± $17,507 in the CLBP group and $3607 ± $10,845 in the control group; P < 0.0001). CONCLUSION: Patients with CLBP are characterized by greater comorbidity and economic burdens compared with those without CLBP. This economic burden can be attributed to greater prescribing of pain-related medications and increased health resource utilization.
研究设计：保险索赔数据库的回顾性分析。 目的：在临床实践中检查慢性下背痛（CLBP）患者的合并症、治疗模式、医疗资源利用和直接医疗费用。 背景资料概要：尽管 CLBP 的社会经济影响很大，但相对于非 CLBP 对照者，CLBP 患者的合并症、与疼痛相关的药物治疗以及医疗资源使用/费用的特征很少有记录。 方法：使用 LifeLink Health Plan Claims Database（IMS Health Inc.，马萨诸塞州沃特敦），使用国际疾病分类，第九修订版，临床修正版（International Classification of Diseases，Ninth Revision，Clinical Modification）确定 CLBP 患者，并与非 CLBP 个体进行匹配（年龄、性别和地区）。在 2008 年期间，比较了两组之间的合并症、与疼痛相关的药物治疗以及医疗服务使用/费用（药房、门诊、住院、总费用）。 结果：共确定了 101294 名 CLBP 患者和对照组（55%为女性；平均年龄为 47.2±11.6 岁）。与对照组相比，CLBP 患者的合并症负担更重，包括肌肉骨骼和神经病理性疼痛疾病以及疼痛的常见后遗症（如抑郁、焦虑和睡眠障碍）的频率明显更高（P<0.0001）。与 CLBP 患者相比，与疼痛相关的药物治疗明显更大（P<0.0001），包括阿片类药物（37.0%比 14.8%；P<0.0001）、非甾体抗炎药（26.2%比 9.6%；P<0.0001）和曲马多（8.2%比 1.2%；P<0.0001）。治疗与疼痛相关的疾病（即抑郁、焦虑和失眠）的“辅助”药物的处方也明显更大（P<0.0001），36.3%的患者接受了联合治疗。CLBP 队列的医疗保健费用明显更高（P<0.0001），反映了资源利用的增加。CLBP 组的总直接医疗费用估计为 8386±17507 美元，对照组为 3607±10845 美元；P<0.0001）。 结论：与没有 CLBP 的患者相比，CLBP 患者的合并症和经济负担更重。这种经济负担可归因于与疼痛相关的药物治疗和增加的健康资源利用。
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