title: Incremental health care costs for chronic pain in Ontario, Canada: a population-based matched cohort study of adolescents and adults using administrative data.
abstract: Little is known about the economic burden of chronic pain and how chronic pain affects health care utilization. We aimed to estimate the annual per-person incremental medical cost and health care utilization for chronic pain in the Ontario population from the perspective of the public payer. We performed a retrospective cohort study using Ontario health care databases and the electronically linked Canadian Community Health Survey (CCHS) from 2000 to 2011. We identified subjects aged ≥12 years from the CCHS with chronic pain and closely matched them to individuals without pain using propensity score matching methods. We used linked data to determine mean 1-year per-person health care costs and utilization for each group and mean incremental cost for chronic pain. All costs are reported in 2014 Canadian dollars. After matching, we had 19,138 pairs of CCHS respondents with and without chronic pain. The average age was 55 years (SD = 18) and 61% were female. The incremental cost to manage chronic pain was $1742 per person (95% confidence interval [CI], $1488-$2020), 51% more than the control group. The largest contributor to the incremental cost was hospitalization ($514; 95% CI, $364-$683). Incremental costs were the highest in those with severe pain ($3960; 95% CI, $3186-$4680) and in those with most activity limitation ($4365; 95% CI, $3631-$5147). The per-person cost to manage chronic pain is substantial and more than 50% higher than a comparable patient without chronic pain. Costs are higher in people with more severe pain and activity limitations.
authors.affiliation: aGraduate Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada bLeslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada cChild Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada dDepartment of Psychology, York University, Toronto, ON, Canada eDepartment of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada fToronto Health Economics and Technology Assessment (THETA) Collaborative, Faculty of Medicine and Pharmacy, University of Toronto, Toronto, ON, Canada gInstitute for Clinical Evaluative Sciences, Toronto, ON, Canada.
authors.forename: Mary-Ellen
authors.initials: ME
authors.lastname: Hogan
authors.forename: Anna
authors.initials: A
authors.lastname: Taddio
authors.forename: Joel
authors.initials: J
authors.lastname: Katz
authors.forename: Vibhuti
authors.initials: V
authors.lastname: Shah
authors.forename: Murray
authors.initials: M
authors.lastname: Krahn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000175:diagnosis / Q000191:economics* / Q000628:therapy; D017281:Cost of Illness; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult