title: Cost Burden of Chronic Pain Patients in a Large Integrated Delivery System in the United States.
abstract: OBJECTIVE
  To estimate all-cause healthcare resource utilization and costs among chronic pain patients within an integrated healthcare delivery system in the United States.
  
  
  METHODS
  Electronic medical records and health claims data from the Henry Ford Health System were used to determine healthcare resource utilization and costs for patients with 24 chronic pain conditions. Patients were identified by ≥ 2 ICD-9-CM codes ≥ 30 days apart from January to December, 2010; the first ICD-9 code was the index event. Continuous coverage for 12 months pre- and postindex was required. All-cause direct medical costs were determined from billing data.
  
  
  RESULTS
  A total of 12,165 patients were identified for the analysis. After pharmacy, the most used resource was outpatient visits, with a mean of 18.8 (SD 13.2) visits per patient for the postindex period; specialty visits accounted for 59.0% of outpatient visits. Imaging was utilized with a mean of 5.2 (SD 5.5) discrete tests per patient, and opioids were the most commonly prescribed medication (38.7%). Annual direct total costs for all conditions were $386 million ($31,692 per patient; a 40% increase from the pre-index). Pharmacy costs comprised 14.3% of total costs, and outpatient visits were the primary cost driver.
  
  
  CONCLUSIONS
  Chronic pain conditions impose a substantial burden on the healthcare system, with musculoskeletal conditions associated with the highest overall costs. Costs appeared to be primarily related to use of outpatient services. This type of research supports integrated delivery systems as a source for assessing opportunities to improve patient outcomes and lower the costs for chronic pain patients.
authors.affiliation: Pfizer Inc., New York, New York, U.S.A.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Henry Ford Health System, Detroit, Michigan, U.S.A.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Dryer
authors.affiliation: Pfizer Inc., New York, New York, U.S.A.
authors.forename: Rozelle
authors.initials: R
authors.lastname: Hegeman-Dingle
authors.affiliation: Pfizer Inc., New York, New York, U.S.A.
authors.forename: Jack
authors.initials: J
authors.lastname: Mardekian
authors.affiliation: Pfizer Inc., New York, New York, U.S.A.
authors.forename: Gergana
authors.initials: G
authors.lastname: Zlateva
authors.affiliation: Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, U.S.A.
authors.forename: Greg G
authors.initials: GG
authors.lastname: Wolff
authors.affiliation: Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, U.S.A.
authors.forename: Lois E
authors.initials: LE
authors.lastname: Lamerato
keywords: chronic pain; economic burden; healthcare costs; musculoskeletal conditions; outpatient services; resource utilization