Costs of shoulder pain and resource use in primary health care: a cost-of-illness study in Sweden

Lena Virta, Pål Joranger, Jens Ivar Brox, Rikard Eriksson, Lena Virta, Pål Joranger, Jens Ivar Brox, Rikard Eriksson

Abstract

Background: Painful shoulders pose a substantial socioeconomic burden. A prospective cost-of-illness study was performed to assess the costs associated with healthcare use and loss of productivity in patients with shoulder pain in primary health care in Sweden.

Methods: The study was performed in western Sweden, in a region with 24 000 inhabitants. Data were collected during six months from electronic patient records at three primary healthcare centres in two municipalities. All patients between 20 and 64 years of age who presented with shoulder pain to a general practitioner or a physiotherapist were included. Diagnostic codes were used for selection, and the cases were manually controlled. The cost for sick leave was calculated according to the human capital approach. Sensitivity analysis was used to explore uncertainty in various factors used in the model.

Results: 204 (103 women) patients, mean age 48 (SD 11) years, were registered. Half of the cases were closed within six weeks, whereas 32 patients (16%) remained in the system for more than six months. A fifth of the patients were responsible for 91% of the total costs, and for 44% of the healthcare costs. The mean healthcare cost per patient was €326 (SD 389) during six months. Physiotherapy treatments accounted for 60%. The costs for sick leave contributed to 84% of the total costs. The mean annual total cost was €4139 per patient. Estimated costs for secondary care increased the total costs by one third.

Conclusions: The model applied in this study provides valuable information that can be used in cost evaluations. Costs for secondary care and particularly for sick leave have a major influence on total costs and interventions that can reduce long periods of sick leave are warranted.

Figures

Figure 1
Figure 1
Distribution of total costs.
Figure 2
Figure 2
Distribution of total healthcare costs.

References

    1. Chaudhury S, Gwilym SE, Moser J, Carr AJ. Surgical options for patients with shoulder pain. Nat Rev Rheumatol. 2010;6(4):217–226. doi: 10.1038/nrrheum.2010.25.
    1. Mitchell C, Adebajo A, Hay E, Carr A. Shoulder pain: diagnosis and management in primary care. BMJ. 2005;331(7525):1124–1128. doi: 10.1136/bmj.331.7525.1124.
    1. Boykin RE, Heuer HJ, Vaishnav S, Millett PJ. Rotator cuff disease - basics of diagnosis and treatment. Rheumatology Rep (Online) 2010;2(1):1–12.
    1. Larson JS, Muller A. Managing the quality of health care. J Health Hum Serv Adm. 2002;25(3):261–280.
    1. Regeringskansliet, Government offices of Sweden. Hälso- och sjukvården i Sverige (Health and medical care in Sweden) Socialdepartementet. Stockholm; 2007.
    1. Nordqvist A, Rahme H, Hovelius L, Etzner M. Axelns sjukdomar. (Shoulder diseases; in Swedish) Lakartidning. 2007;104(19):1492–1496.
    1. Vitale MA, Arons RR, Hurwitz S, Ahmad CS, Levine WN. The rising incidence of acromioplasty. J Bone Joint Surg Am. 2010;92(9):1842–1850. doi: 10.2106/JBJS.I.01003.
    1. Park HB, Yokota A, Gill HS, El Rassi G, McFarland EG. Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome. J Bone Joint Surg Am. 2005;87(7):1446–1455. doi: 10.2106/JBJS.D.02335.
    1. Henkus HE, de Witte PB, Nelissen RG, Brand R, van Arkel ER. Bursectomy compared with acromioplasty in the management of subacromial impingement syndrome: a prospective randomised study. J Bone Joint Surg Br. 2009;91(4):504–510. doi: 10.1302/0301-620X.91B4.21442.
    1. Moosmayer S, Lund G, Seljom U, Svege I, Hennig T, Tariq R, Smith HJ. Comparison between surgery and physiotherapy in the treatment of small and medium-sized tears of the rotator cuff: a randomised controlled study of 103 patients with one-year follow-up. J Bone Joint Surg Br. 2010;92(1):83–91. doi: 10.1302/0301-620X.92B1.22609.
    1. Brox JI, Gjengedal E, Uppheim G, Bohmer AS, Brevik JI, Ljunggren AE, Staff PH. Arthroscopic surgery versus supervised exercises in patients with rotator cuff disease (stage II impingement syndrome): a prospective, randomized, controlled study in 125 patients with a 2 1/2-year follow-up. J Shoulder Elbow Surg. 1999;8(2):102–111. doi: 10.1016/S1058-2746(99)90001-0.
    1. Haahr JP, Andersen JH. Exercises may be as efficient as subacromial decompression in patients with subacromial stage II impingement: 4-8-years' follow-up in a prospective, randomized study. Scand J Rheumatol. 2006;35(3):224–228. doi: 10.1080/03009740600556167.
    1. Ketola S, Lehtinen J, Arnala I, Nissinen M, Westenius H, Sintonen H, Aronen P, Konttinen YT, Malmivaara A, Rousi T. Does arthroscopic acromioplasty provide any additional value in the treatment of shoulder impingement syndrome?: a two-year randomised controlled trial. J Bone Joint Surg Br. 2009;91(10):1326–1334. doi: 10.1302/0301-620X.91B10.22094.
    1. Virta L, Mortensen M, Eriksson R, Möller M. How many patients with subacromial impingement syndrome recover with physiotherapy? A follow-up study of a supervised exercise programme. Advances in Physiotherapy. 2009;11(3):166–173. doi: 10.1080/14038190802460481.
    1. Kuijpers T, van Tulder MW, van der Heijden GJ, Bouter LM, van der Windt DA. Costs of shoulder pain in primary care consulters: a prospective cohort study in The Netherlands. BMC Musculoskelet Disord. 2006;7:83. doi: 10.1186/1471-2474-7-83.
    1. Nilsson G, Ahlfeldt H, Strender LE. Computerisation, coding, data retrieval and related attitudes among Swedish general practitioners-a survey of necessary conditions for a database of diseases and health problems. Int J Med Inform. 2002;65(2):135–143. doi: 10.1016/S1386-5056(02)00012-6.
    1. Nilsson G, Ahlfeldt H, Strender LE. Textual content, health problems and diagnostic codes in electronic patient records in general practice. Scand J Prim Health Care. 2003;21(1):33–36. doi: 10.1080/02813430310000537.
    1. Ekman M, Jönhagen S, Hunsche E, Jönsson L. Burden of illness of chronic low back pain in Sweden. SPINE. 2005;30(15):1777–1785. doi: 10.1097/01.brs.0000171911.99348.90.
    1. Wirehn AB, Andersson A, Ostgren CJ, Carstensen J. Age-specific direct healthcare costs attributable to diabetes in a Swedish population: a register-based analysis. Diabet Med. 2008;25(6):732–737. doi: 10.1111/j.1464-5491.2008.02444.x.
    1. Carlsson L, Borjesson U, Edgren L. Patient based 'burden-of-illness' in Swedish primary health care. Applying the Johns Hopkins ACG case-mix system in a retrospective study of electronic patient records. Int J Health Plann Manage. 2002;17(3):269–282. doi: 10.1002/hpm.674.
    1. Murphy R, Carr A. Management of shoulder pain in general practice. InnovAiT. 2009;2(7):402–407. doi: 10.1093/innovait/inp044.
    1. Robb G, Arroll B, Duncan R, Goodyear-Smith F. Summary of an evidence-based guideline on soft tissue shoulder injuries and related disorders - part 2: management. J Primary Health Care. 2009;1(1):42–49.
    1. Geraets JJ, de Jongh AC, Boeke AJ, Buis PA, Spinnewijn WE, Geijer RM, Goudswaard AN. Summary of the practice guideline for shoulder complaints from the Dutch College of General Practitioners. Ned Tijdschr Geneeskd. 2009;153:A164.
    1. Gotaland CoV, editor. Price list for the Western Health Care Region in Sweden 2009 (Prislista för Västra sjukvårdsregionen, Utomlänspriser 2009. För vårdtjänster enligt samverkansavtal om hälso- och sjukvård inom Västra Sjukvårdsregionen) Skovde, Sweden; 2009.
    1. Drummond M, Sculpher MJ, Torrance GW, O'Brien BJ, Stoddard GL. Methods for the economic evaluation of health care programmes. 3. Oxford: Oxford University Press; 2005.
    1. van Tulder MW, Koes BW, Bouter LM. A cost-of-illness study of back pain in The Netherlands. Pain. 1995;62:233–240. doi: 10.1016/0304-3959(94)00272-G.
    1. Malmquist C. Kostnader i samband med arbetsbetingad ohälsa och stress. (publication on costs for productivity loss in relation to work-induced illness and stress) Regeringskansliet, (). Stockholm; 2001.
    1. Schulper M. In: Economic evaluation in health care - merging theory with practice. Drummond M, McGuire A, editor. Oxford: Oxford University Press; 2001. The role of estimation of productivity cost in economic evaluation; pp. 93–111.
    1. Koopmanschap MA, Rutten FF, van Ineveld BM, van Roijen L. The friction cost method for measuring indirect costs of disease. J Health Econ. 1995;14(2):171–189. doi: 10.1016/0167-6296(94)00044-5.
    1. Taylor M. What is sensitivity analysis. Consortium YHE: University of York; 2009. pp. 1–8.
    1. Seferlis T, Lindholm L, Nemeth G. Cost-minimisation analysis of three conservative treatment programmes in 180 patients sick-listed for acute low-back pain. Scand J Prim Health Care. 2000;18(1):53–57. doi: 10.1080/02813430050202578.
    1. Dorrestijn O, Stevens M, Diercks RL, van der Meer K, Winters JC. A new interdisciplinary treatment strategy versus usual medical care for the treatment of subacromial impingement syndrome: a randomized controlled trial. BMC Musculoskelet Disord. 2007;8:15. doi: 10.1186/1471-2474-8-15.
    1. Murphy RJ, Carr AJ. Shoulder pain. Clin Evid (Online) 2010. Jul 22; 2010.pii: 1107.
    1. Hofmann B. Is there a technological imperative in health care. Int J Technol Assess Health Care. 2002;18(3):675–689.
    1. Geraets JJ, Goossens ME, de Bruijn CP, Koke AJ, de Bie RA, Pelt RA, van den Heuvel WJ, van der Heijden GJ. A behavioural treatment for chronic shoulder complaints: concepts, development, and study design. Aust J Physiother. 2004;50(1):33–38.
    1. Geraets JJ, Goossens ME, de Bruijn CP, de Groot IJ, Koke AJ, Pelt RA, Van der Heijden G, Dinant GJ, van den Heuvel WJ. Cost-effectiveness of a graded exercise therapy program for patients with chronic shoulder complaints. Int J Technol Assess Health Care. 2006;22(1):76–83.
    1. Faber E, Kuiper JI, Burdorf A, Miedema HS, Verhaar JA. Treatment of impingement syndrome: a systematic review of the effects on functional limitations and return to work. J Occup Rehabil. 2006;16(1):7–25.
    1. Storro S, Moen J, Svebak S. Effects on sick-leave of a multidisciplinary rehabilitation programme for chronic low back, neck or shoulder pain: comparison with usual treatment. J Rehabil Med. 2004;36(1):12–16. doi: 10.1080/11026480310015521.
    1. Westman A, Linton SJ, Theorell T, Ohrvik J, Wahlen P, Leppert J. Quality of life and maintenance of improvements after early multimodal rehabilitation: a 5-year follow-up. Disabil Rehabil. 2006;28(7):437–446. doi: 10.1080/09638280500192694.
    1. Karjalainen K, Malmivaara A, van Tulder M, Roine R, Jauhiainen M, Hurri H, Koes B. Multidisciplinary biopsychosocial rehabilitation for subacute low back pain among working age adults. Cochrane Database Syst Rev. 2003. Art. No: CD002194. DOI: 10.1002/14651858.CD002194.
    1. Österås H, Torstensen TA, Arntzen G, Österås BS. A comparison of work absence periods and the associated costs for two different modes of exercise therapies for patients with longstanding subacromial pain. J Med Econ. 2008;11(3):371–181. doi: 10.3111/13696990802191564.
    1. De Bruijn C, Goossens M, de Bie R, Ament A, Geraets J, Dinant GJ. Cost-effectiveness of an education and activation program for patients with acute and subacute shoulder complaints compared to usual care. Int J Technol Assess Health Care. 2007;23(1):80–88.
    1. Bergman GJ, Winter JC, van Tulder MW, Meyboom-de Jong B, Postema K, van der Heijden GJ. Manipulative therapy in addition to usual medical care accelerates recovery of shoulder complaints at higher costs: economic outcomes of a randomized trial. BMC Musculoskeletal Disorders. 2010;11:200. doi: 10.1186/1471-2474-11-200.
    1. Feleus A, Bierma-Zeinstra SM, Miedema HS, Verhaar JA, Koes BW. Management in non-traumatic arm, neck and shoulder complaints: differences between diagnostic groups. Eur Spine J. 2008;17(9):1218–1229. doi: 10.1007/s00586-008-0710-1.
    1. Miranda H, Viikari-Juntura E, Heistaro S, Heliovaara M, Riihimaki H. A population study on differences in the determinants of a specific shoulder disorder versus nonspecific shoulder pain without clinical findings. Am J Epidemiol. 2005;161(9):847–855. doi: 10.1093/aje/kwi112.
    1. Brox JI. Regional musculoskeletal conditions: shoulder pain. Best Pract Res Clin Rheumatol. 2003;17(1):33–56. doi: 10.1016/S1521-6942(02)00101-8.
    1. Bennell K, Coburn S, Wee E, Green S, Harris A, Forbes A, Buchbinder R. Efficacy and cost-effectiveness of a physiotherapy program for chronic rotator cuff pathology: a protocol for a randomised, double-blind, placebo-controlled trial. BMC Musculoskelet Disord. 2007;8:86. doi: 10.1186/1471-2474-8-86.
    1. Kromer TO, de Bie RA, Bastiaenen CH. Effectiveness of individualized physiotherapy on pain and functioning compared to a standard exercise protocol in patients presenting with clinical signs of subacromial impingement syndrome. A randomized controlled trial. BMC Musculoskelet Disord. 2010;11:114. doi: 10.1186/1471-2474-11-114.
    1. Koopmanschap MA. Cost-of-illness studies. Useful for health policy. Pharmacoecon. 1998;14(2):143–148. doi: 10.2165/00019053-199814020-00001.
    1. Grovle L, Haugen AJ, Keller A, Natvig B, Brox JI, Grotle M. Poor agreement found between self-report and a public registry on duration of sickness absence. J Clin Epidemiol. 2012;65(2):212–218. doi: 10.1016/j.jclinepi.2011.05.009. Epub 2011 Aug 17.
    1. Rice DP. Cost of illness studies: what is good about them. Inj Prev. 2000;6(3):177–179. doi: 10.1136/ip.6.3.177.
    1. Oostenbrink JB, Koopmanschap MA, Rutten FF. Standardisation of costs: the Dutch manual for costing in economic evaluations. Pharmacoecon. 2002;20(7):443–454. doi: 10.2165/00019053-200220070-00002.

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