In 2016, Americans spent $134.5 billion on low back and neck pain – more than on any other condition.

When combined with all other musculoskeletal disorders, such as joint and limb pain, osteoarthritis, and rheumatoid arthritis, the total exceeds $380 billion, according to a new study.

These numbers may not come as a surprise to the 85% of employers who rank MSK conditions in their top three sources of healthcare spend.

Around 60% of those with low back or neck pain are of working age – one reason self-insured employers bear so much of the cost of care.

“That’s something that’s quite different from a lot of the other health conditions that we look at,”  Dr. Joseph Dieleman of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington’s School of Medicine and lead author of the study told Fern Health. “It also impacts the way we think about where the resources are coming from for that $135 billion.”

Public insurance covers larger portions of spending on other costly conditions like diabetes and heart disease. 

Another difference? Unlike diabetes, prevalence rates of low back and neck pain have remained steady over the last 20 years. That means around the same percentage of people have low back and neck pain as they did in 1996. Patients today are just spending a lot more to treat it.

“The major increases have little to do with more people with low back and neck pain,” said Dr. Dieleman. 

Instead, the main increases in spending for low back and neck pain can be attributed to two factors: More expensive inpatient care, and more frequent outpatient care. 

On the inpatient side, while the volume of patients receiving surgery is lower than for outpatient services, the spending per patient or per surgery contributes significantly to high costs, Dr. Dieleman said. 

Surgeries for low back and neck pain have increased, as well. Between the years 1998 and 2011, the number of spinal fusion procedures more than doubled, according to the United States Bone and Joint Initiative.

While hospital stays have gotten shorter, the costs per day in the hospital have risen significantly. As of 2011, the average hospitalization charge for spinal fusion, a common lower back surgical option, was $102,000. In 1998, the average charge was only $26,000.

As for outpatient services, costs have gone up some, but the main increase in spending has come from more people seeking out back and neck pain services, Dr. Dieleman said. The outpatient numbers include any services that can be charged to an insurance company, including primary care visits, chiropractic services, and prescribed massage.

“Prices have gone up just a little in outpatient clinics, but the big increase has been in utilization of outpatient care,” said Dr. Dieleman.

So has all of this spending led to better outcomes? The data analysis doesn’t answer that question directly, Dr. Dieleman said, but combining a couple of important data series can provide some clues. 

Again, back and neck pain prevalence has remained steady over the years. The health burden, or loss of healthy life associated with low back and neck pain, has also remained largely flat. 

“The health burden is staying about the same, but spending is going through the roof,” Dr. Dieleman said. “We have huge spending increases and not much to show for it.”

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