title: Costs associated with treatment of chronic low back pain: an analysis of the UK General Practice Research Database.
abstract: METHODS
  Retrospective cohort study of health care costs associated with the treatment of chronic low back pain (CLBP) in the United Kingdom.
  
  
  OBJECTIVE
  To assess 12-month health care costs associated with the treatment of CLBP, using the UK General Practice Research Database.
  
  
  BACKGROUND
  CLBP is a common health problem.
  
  
  METHODS
  Data were obtained from the General Practice Research Database, a computerized database of UK primary care patient data. Patients with CLBP were identified for the study period (January 1, 2007, to December 31, 2009) using diagnostic records and pain relief prescriptions (n = 64,167), and 1:1 matched to patients without CLBP (n = 52,986) on the basis of age, sex, and general practitioner's practice. Index date was defined as the first date of CLBP record; the same index date was assigned to matched controls. Multivariate analyses were performed to compare resource use costs (2009 values) in the 12 months after the index date between patients with and without CLBP. A sensitivity analysis was carried out with a more stringent definition for the control group by excluding a broad range of pain conditions.
  
  
  RESULTS
  Total health care costs for patients with CLBP were double those of the matched controls (£1074 vs. £516; P < 0.05). Of the cost difference, 58.8% was accounted for by general practitioner's consultations, 22.3% by referrals to secondary care, and the rest by pain relief medications. The sensitivity analysis revealed an even greater cost difference between the 2 groups (£1052 vs. £304; P < 0.05). Because of the use of a retrospective administrative claims database, this study is subject to selection bias between study cohorts, misidentification of comorbidities, and an inability to confirm adherence to therapy or assess indirect costs and costs of over-the-counter medications.
  
  
  CONCLUSIONS
  Our findings confirm the substantial economic burden of CLBP, even with direct costs only.
authors.affiliation: Personal Social Services Research Unit, London School of Economics and Political Science, London, United Kingdom. j.hong@lse.ac.uk
authors.forename: Jihyung
authors.initials: J
authors.lastname: Hong
authors.forename: Catherine
authors.initials: C
authors.lastname: Reed
authors.forename: Diego
authors.initials: D
authors.lastname: Novick
authors.forename: Michael
authors.initials: M
authors.lastname: Happich
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059350:Chronic Pain / Q000191:economics* / Q000628:therapy*; D015331:Cohort Studies; D016208:Databases, Factual / Q000191:economics; D005260:Female; D058006:General Practice / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D017116:Low Back Pain / Q000191:economics* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult