title: Inefficiencies in osteoarthritis and chronic low back pain management.
abstract: OBJECTIVE
  To identify inefficiencies in drug and medical service utilization related to pain management in patients with osteoarthritis and chronic low back pain.
  
  
  METHODS
  This retrospective cohort study applied revised measures of pain management inefficiencies to Humana Medicare members with osteoarthritis and/or chronic low back pain.
  
  
  METHODS
  Subjects had either 2 or more claims for osteoarthritis on different days or 2 or more claims for low back pain 90 or more days apart, from January 1, 2008, to June 30, 2010, with the first occurrence assigned the index date. Inefficiencies were identified for 365 days postindex.Pain-related healthcare costs postindex were compared between members with and without inefficiencies. A generalized linear model calculated adjusted costs per member controlling for age, sex, and comorbidities.
  
  
  RESULTS
  Most members diagnosed with osteoarthritis, chronic low back pain, or both (N = 68,453) had at least 1 inefficiency measure (n = 37,863) during the postindex period. High per member costs were for repeated surgical procedures ($26,451) and inpatient admissions ($19,372) compared with members without inefficiencies ($781; P < .0001). High total costs (prevalence times per member cost) were for repeated diagnostic testing and excessive office visits. Members with an inefficiency had adjusted pain-related costs 5.42 times higher than those of members without an inefficiency (P <.0001).
  
  
  CONCLUSIONS
  Pain management inefficiencies are common and costly among Humana Medicare members with osteoarthritis and/or chronic low back pain. Further work by providers and payers is needed to determine benefits of member identification and early intervention for these inefficiencies.
authors.affiliation: Principal Researcher, Comprehensive Health Insights, Inc, 325 W Main St WFP6W, Louisville, KY 40202. E-mail: mpasquale@humana.com.
authors.forename: Margaret K
authors.initials: MK
authors.lastname: Pasquale
authors.forename: Robert
authors.initials: R
authors.lastname: Dufour
authors.forename: Ashish V
authors.initials: AV
authors.lastname: Joshi
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Reiners
authors.forename: David
authors.initials: D
authors.lastname: Schaaf
authors.forename: Jack
authors.initials: J
authors.lastname: Mardekian
authors.forename: George A
authors.initials: GA
authors.lastname: Andrews
authors.forename: Nick C
authors.initials: NC
authors.lastname: Patel
authors.forename: James
authors.initials: J
authors.lastname: Harnett
mesh_terms: D000293:Adolescent; D000328:Adult; D059350:Chronic Pain / Q000191:economics / Q000628:therapy; D006801:Humans; D007345:Insurance Claim Review; D017116:Low Back Pain / Q000191:economics / Q000628:therapy*; D008875:Middle Aged; D010003:Osteoarthritis / Q000191:economics / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D059408:Pain Management / Q000191:economics* / Q000592:standards; D011787:Quality of Health Care; D012189:Retrospective Studies; D055815:Young Adult