title: The economic impact of chronic pain: a nationwide population-based cost-of-illness study in Portugal.
abstract: In addition to its high frequency and relevant individual and social impact, chronic pain (CP) has been shown to be a major contributor to increased healthcare utilisation, reduced labour productivity, and consequently large direct and indirect costs. In the context of a larger nationwide study, we aimed to assess the total annual direct and indirect costs associated with CP in Portugal. A population-based study was conducted in a representative sample of the Portuguese adult population. The 5,094 participants were selected using random digit dialling and contacted by computer-assisted telephone interviews. Questionnaires included the brief pain inventory and pain disability index. Estimates were adequately weighted for the population. From all CP subjects identified, a subsample (n = 562) accepted to participate in this economic study. Mean total annualised costs per CP subject of €1,883.30 were observed, amounting to €4,611.69 million nationally, with 42.7% direct and 57.3% indirect costs, and corresponding to 2.71% of the Portuguese annual GDP in 2010. Only socio-demographic variables were significantly and independently associated with CP costs, and not CP severity, raising the possibility of existing inequalities in the distribution of healthcare in Portugal. The high economic impact of CP in Portugal was comprehensively demonstrated. Given the high indirect costs observed, restricting healthcare services is not a rational response to these high societal costs; instead improving the quality of CP prevention and management is recommended.
authors.affiliation: Department of Health Information and Decision Sciences (CIDES), Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n, 4200-319, Porto, Portugal. lazevedo@med.up.pt.|Centre for Research in Health Technologies and Information Systems (CINTESIS), University of Porto, Porto, Portugal. lazevedo@med.up.pt.|Centro Nacional de Observação em Dor (OBSERVDOR, Portuguese National Pain Observatory), Porto, Portugal. lazevedo@med.up.pt.
authors.forename: Luís Filipe
authors.initials: LF
authors.lastname: Azevedo
authors.affiliation: Department of Health Information and Decision Sciences (CIDES), Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n, 4200-319, Porto, Portugal.|Centre for Research in Health Technologies and Information Systems (CINTESIS), University of Porto, Porto, Portugal.|Centro Nacional de Observação em Dor (OBSERVDOR, Portuguese National Pain Observatory), Porto, Portugal.
authors.forename: Altamiro
authors.initials: A
authors.lastname: Costa-Pereira
authors.affiliation: Centro Nacional de Observação em Dor (OBSERVDOR, Portuguese National Pain Observatory), Porto, Portugal.
authors.forename: Liliane
authors.initials: L
authors.lastname: Mendonça
authors.affiliation: Department of Health Information and Decision Sciences (CIDES), Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n, 4200-319, Porto, Portugal.|Centre for Research in Health Technologies and Information Systems (CINTESIS), University of Porto, Porto, Portugal.
authors.forename: Cláudia Camila
authors.initials: CC
authors.lastname: Dias
authors.affiliation: Centro Nacional de Observação em Dor (OBSERVDOR, Portuguese National Pain Observatory), Porto, Portugal.|Department of Experimental Biology, Faculty of Medicine, University of Porto, Porto, Portugal.|Institute for Molecular and Cell Biology (IBMC), University of Porto, Porto, Portugal.
authors.forename: José M
authors.initials: JM
authors.lastname: Castro-Lopes
mesh_terms: D000041:Absenteeism; D000293:Adolescent; D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000191:economics*; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D011174:Portugal / Q000453:epidemiology; D012179:Retirement / Q000191:economics; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Chronic pain; Cost of illness; Costs; Economic impact; Productivity