Certain Risk Factors Could Predict High Costs for Patients with Musculoskeletal Pain

A new analysis from the DCRI showed that 35 percent of direct costs related to musculoskeletal pain were attributable to about 4 percent of patients who were persistent high-cost utilizers.

Health care delivery models that take into consideration risk factors such as physical and mental health may help alleviate the burden of high costs for patients with musculoskeletal pain, according to recent DCRI-led research.

An analysis led by the DCRI’s Trevor Lentz, PT, PhD, MPH, and recently published in PLOS One, examined health care utilization costs and other patient characteristics in a sample of nearly 13,000 patients with musculoskeletal pain drawn from Medical Expenditure Panel Survey data between 2008 and 2013. Because musculoskeletal pain can be a chronic condition, the study team wanted to find out which factors contributed to high health care costs over time.

Findings showed that 35 percent of direct costs related to musculoskeletal pain were attributable to about 4 percent of patients. Persistent high cost utilization was related to non-modifiable variables such as age, race, poverty level, geographic region, insurance status, diagnosis type, and total number of diagnoses. However, modifiable variables also contributed to risk of high costs, including higher number of days missed at work, greater pain interference, and higher use of prescription medication for pain. Conversely, those who reported to have better mental and physical health were less likely to become high-cost utilizers over time.

“Because we now better understand the factors that are associated with persistently high health care costs, we may be able to prospectively identify the individuals who are at great risk of carrying this burden by looking at demographic and health information for our patients, as well as pain-related characteristics,” Lentz said. “We also may be able to decrease costs for some of these patients by addressing modifiable risk factors within our health care delivery systems.”

“This analysis adds to the conversation because it is, to our knowledge, the first study that examines persistence of high costs for musculoskeletal pain in the U.S,” said Steven George, PT, PhD, FAPTA, who also contributed to the study. “Studies have been conducted in other countries with single-payer systems, but those data do not always translate well to the U.S., where we know that socioeconomic status and insurance status can have a significant impact on health care costs. Further research is needed to be able to ascertain when these high costs are necessary for good musculoskeletal outcomes, versus when they are indicative of low-value care.”