The economic burden of back pain in the UK Nikolaos Maniadakis a , Alastair Gray b, * a Global Health Outcomes, Searle Division of Monsanto, P.O. Box 53, High Wycombe, Bucks HP12 4HL, UK b Health Economics Research Centre, Institute of Health Sciences, University of Oxford, Old Road, Headington, Oxford OX3 7LF, UK Received 23 October 1998; received in revised form 30 June 1999; accepted 15 July 1999 Abstract This paper reports the results of a `cost-of-illness' study of the socio-economic costs of back pain in the UK. It estimates the direct health care cost of back pain in 1998 to be £1632 million. Approximately 35% of this cost relates to services provided in the private sector and thus is most likely paid for directly by patients and their families. With respect to the distribution of cost across different providers, 37% relates to care provided by physiotherapists and allied specialists, 31% is incurred in the hospital sector, 14% relates to primary care, 7% to medication, 6% to community care and 5% to radiology and imaging used for investigation purposes. However, the direct cost of back pain is insigni®cant compared to the cost of informal care and the production losses related to it, which total £10668 million. Overall, back pain is one of the most costly conditions for which an economic analysis has been carried out in the UK and this is in line with ®ndings in other countries. Further research is needed to establish the cost-effectiveness of alternative back pain treatments, so as to minimise cost and maximise the health bene®t from the resources used in this area. q 2000 International Association for the Study of Pain. Published by Elsevier Science B.V. Keywords: Back pain; Economic burden 1. Introduction Back pain may not be a life threatening condition, but it constitutes a major public health problem in Western indus- trialised societies and exhibits epidemic proportions (Deyo, 1998). It affects a large number of people each year and is the cause of great discomfort and economic loss. Interna- tional studies have reported point prevalence rates between 12% and 35% and lifetime prevalence rates ranging from 49% to 80% (Biering-Sorensen, 1982, 1983; Frymoyer et al., 1983; Deyo and Tsui-Wu, 1987; Waddell, 1987; Frymoyer, 1988; Loeser and Volinn, 1991; Rossignoll et al., 1993; Walsh et al., 1993; Clinical Standards Advisory Group (CSAG), 1994; Croft et al., 1994 Of®ce of Population Censuses and Surveys (OPCS), 1994; Scovron et al., 1994). Because of its high prevalence, back pain is a leading reason for physician visits, hospitalisations and other health and social care service utilisation. Additionally, it creates disability and work loss, which in recent years have increased more rapidly than any other common form of incapacity in Britain: between 1986 and 1992 back pain disability rose by 104%, whereas disability for other reasons rose by 60% (Moffett et al., 1995). As a result, in 1994±1995 116 million production days were lost due to incapacity to work related to back pain (Department of Social Security (DSS), 1998). Recent surveys also indicate that back pain results in restrictions of social and other activities and has substantial impact on the life style of those affected (Of®ce of Population Censuses and Surveys (OPCS), 1997; Walsh et al., 1993; Croft et al., 1994). Similar ®ndings have been reported in other countries (Andersson et al., 1983; Grazier et al., 1984; Abenhaim et al., 1985; Spitzer et al., 1987; Waddell, 1987; Frymoyer and Cats-Baril, 1991; van Turder et al., 1995). This substantial epidemiological and economic impact of back pain on society is expected to increase further, due to a combination of changing attitudes and expectations, chan- ging methods of medical management and changing social provision. It therefore seems appropriate to attempt an accu- rate assessment in monetary terms of the current burdens imposed by back pain on patients, the health care system and society as a whole in the UK, within a `cost of illness' framework. Cost of illness studies indicate the relative signi®cance of particular conditions and show the con®g- uration of costs across different parties, thus indicating the potential scope for reduction in the burden of the disease and the main targets of health research and policy measures. Pain 84 (2000) 95±103 0304-3959/00/$20.00 q 2000 International Association for the Study of Pain. Published by Elsevier Science B.V. PII: S0304-3959(99)00187-6 www.elsevier.nl/locate/pain * Corresponding author. Tel.: 144-1865-226687; fax: 144-1865- 226842. E-mail address: alastair.gray@ihs.ox.ac.uk (A. Gray)