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Pain Conditions Ranked by Healthcare Costs for Members of a National Health Plan
Author(s) -
Pasquale Margaret K.,
Dufour Robert,
Schaaf David,
Reiners Andrew T.,
Mardekian Jack,
Joshi Ashish V.,
Patel Nick C.
Publication year - 2014
Publication title -
pain practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 58
eISSN - 1533-2500
pISSN - 1530-7085
DOI - 10.1111/papr.12066
Subject(s) - medicine , health care , total cost , population , back pain , physical therapy , environmental health , business , alternative medicine , accounting , pathology , economics , economic growth
Healthcare resource utilization ( HCRU ) and associated costs specific to pain are a growing concern, as increasing dollar amounts are spent on pain‐related conditions. Understanding which pain conditions drive the highest utilization and cost burden to the healthcare system would enable providers and payers to better target conditions to manage pain adequately and efficiently. The current study focused on 36 noncancer chronic and 14 noncancer acute pain conditions and measured the HCRU and costs per member over 365 days. These conditions were ranked by per‐member costs and total adjusted healthcare costs to determine the most expensive conditions to a national health plan. The top 5 conditions for the commercial line of business were back pain, osteoarthritis ( OA ), childbirth, injuries, and non‐hip, non‐spine fractures (adjusted annual total costs for the commercial members were $119 million, $98 million, $69 million, $61 million, and $48 million, respectively). The top 5 conditions for M edicare members were OA , back pain, hip fractures, injuries, and non‐hip, non‐spine fractures (adjusted annual costs for the M edicare members were $327 million, $218 million, $117 million, $82 million, and $67 million, respectively). The conditions ranked highest for both per‐member and total healthcare costs were hip fractures, childbirth, and non‐hip, non‐spine fractures. Among these, hip fractures in the M edicare member population had the highest mean cost per member (adjusted per‐member cost was $21,058). Further examination specific to how pain is managed in these high‐cost conditions will enable providers and payers to develop strategies to improve patient outcomes through appropriate pain management.