Pain severity and the economic burden of neuropathic pain in the United States: BEAT Neuropathic Pain Observational Study.
BACKGROUND
As with many chronic conditions, patients with neuropathic pain (NeP) are high consumers of health care resources. However, limited literature exists on the economic burden of NeP, including its impact on productivity. The aim of this study was to characterize health care resource utilization, productivity, and costs associated with NeP by pain severity level in US adults.


METHODS
Subjects (n=624) with painful diabetic peripheral neuropathy, human immunodeficiency virus-related peripheral NeP, post-trauma/post-surgical NeP, spinal cord injury with NeP, chronic low back pain with NeP, and small fiber neuropathy were recruited during routine office visits to US community-based general practitioners and specialists. Clinicians captured clinical characteristics, NeP-related medications, and health care resource utilization based on 6-month retrospective medical chart review. Subjects completed questionnaires on demographics, pain/symptoms, costs, and productivity. Brief Pain Inventory pain severity scores were used to classify subjects by mild, moderate, or severe pain. Annualized NeP-related costs (adjusted for covariates) were estimated, and differences across pain severity groups were evaluated.


RESULTS
In total, 624 subjects were recruited (mean age 55.5±13.7 years; 55.4% male), and 504/624 (80.8%) reported moderate or severe pain. Statistically significant differences were observed across pain severity levels for number of comorbidities, prescription medications, physician office visits, and lost productivity (all P≤0.0001). At all pain severity levels, indirect costs were the primary cost driver. After adjusting for demographic and clinical variables, total mean (95% confidence interval [CI]) annualized direct medical costs to payers, direct costs to subjects, and indirect costs per subject were US$6,016 (95% CI 5,316-6,716), US$2,219 (95% CI 1,919-2,519), and US$19,000 (95% CI 17,197-20,802), respectively, with significant differences across pain severity levels.


CONCLUSIONS
Subjects with NeP, mainly those showing moderate or severe pain, had significant associations between pain severity and NeP-related health care resource utilization, productivity, and costs. The economic burden, particularly indirect costs, was highest among those with severe pain and higher than previously reported in studies of specific NeP conditions.
Covance Market Access Services Inc., Gaithersburg, MD, USA.
Caroline
C
Schaefer
Pfizer, Inc., New York, NY, USA.
Alesia
A
Sadosky
Covance Market Access Services Inc., San Diego, CA, USA.
Rachael
R
Mann
Covance Market Access Services Inc., Conshohocken, PA, USA.
Shoshana
S
Daniel
Pfizer, Inc., New York, NY, USA.
Bruce
B
Parsons
Palm Beach Neurological Center, Palm Beach Gardens, FL, USA.
Michael
M
Tuchman
Rehabilitation Institute of Chicago, Chicago, IL, USA.
Alan
A
Anschel
Oregon Health and Science University, Portland, OR, USA.
Brett R
BR
Stacey
International Clinical Research Institute, Overland Park, KS, USA.
Srinivas
S
Nalamachu
Rehabilitation Institute of Michigan/Wayne State University, Detroit, MI, USA.
Edward
E
Nieshoff
burden of illness; health care costs; health care resource use; neuropathic pain management; productivity