Coyte P C, Asche C V, Croxford R, Chan B
Department of Health Administration and Institute for Policy Analysis, University of Toronto, Ontario, Canada.
Arthritis Care Res. 1998 Oct;11(5):315-25. doi: 10.1002/art.1790110503.
This study estimated the total cost of musculoskeletal disorders for Canadians in 1994 and assessed the sensitivity of these cost estimates to variations in the definition of musculoskeletal disorders.
Disease-related costs, from a societal perspective, were measured using a prevalence-based analysis. First, direct treatment costs, including expenditures on hospitals and other institutions, physicians and other health professionals, drugs, research, and other items were assessed. Second, indirect costs associated with lost (or foregone) productivity due to disability and premature mortality were evaluated using the human capital approach.
The total cost of musculoskeletal disorders in Canada was $25.6 billion (in 1994 Canadian dollars, $1.00 CDN approximately $0.75 US) or 3.4% of the gross domestic product. Direct and indirect costs were estimated at $7.5 billion and $18.1 billion, respectively. Lower and upper bound estimates of the total cost of musculoskeletal disorders, derived from the sensitivity analysis, were $19.9 billion and $30.8 billion, respectively. Wide variations were reported in the total cost of various musculoskeletal disorder subcategories, with the highest costs reported for injuries ($10.7 billion), back and spine disorders ($8.1 billion), and arthritis and rheumatism ($5.9 billion).
The economic cost of musculoskeletal disorders was substantial and was sensitive to the definition of musculoskeletal disorders and other underlying assumptions. The hallmark of this study was the variation between subcategories in their cost, pattern of health resource use, and sequelae. The cost estimates may provide guidance in setting priorities for research and prevention activities.
本研究估算了1994年加拿大人肌肉骨骼疾病的总成本，并评估了这些成本估算对肌肉骨骼疾病定义变化的敏感性。
从社会角度出发，使用基于患病率的分析方法来衡量与疾病相关的成本。首先，评估直接治疗成本，包括医院和其他机构、医生和其他卫生专业人员、药物、研究及其他项目的支出。其次，采用人力资本方法评估因残疾和过早死亡导致的生产力损失（或放弃）所产生的间接成本。
加拿大肌肉骨骼疾病的总成本为256亿加元（以1994年加拿大元计，1.00加元约合0.75美元），占国内生产总值的3.4%。直接成本和间接成本估计分别为75亿加元和181亿加元。敏感性分析得出的肌肉骨骼疾病总成本的下限和上限估计分别为199亿加元和308亿加元。据报告，各种肌肉骨骼疾病亚类的总成本差异很大，其中损伤（107亿加元）、背部和脊柱疾病（81亿加元）以及关节炎和风湿病（59亿加元）的成本最高。
肌肉骨骼疾病的经济成本巨大，且对肌肉骨骼疾病的定义和其他基本假设敏感。本研究的特点是各亚类在成本、卫生资源使用模式和后遗症方面存在差异。成本估计可为确定研究和预防活动的优先事项提供指导。
