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Appendix C: The Economic Costs of Pain in the United States
Pages 301-338

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From page 301...
... Appendix C The Economic Costs of Pain in the United States Darrell J Gaskin, Ph.D.
From page 302...
... To compute the annual economic cost of pain, we defined persons with pain as those who reported having "severe pain," "moderate pain," "joint pain," "arthritis," or functional limitation that restricted their ability to work. To compute the cost of medical care for patients with a primary diagnosis of pain, we examined adults who were treated for headache, abdominal pain, chest pain, and back pain in 2008.
From page 303...
... reported that the annual cost of pharmaceuticals for pain management was $16.4 billion, and the cost of lumbar surgeries was $2.9 billion. Their estimates of the indirect costs of pain were $18.9 billion for disability compensation and $6.9 billion for productivity loss.
From page 304...
... They computed indirect costs using data on disability compensation and estimates of lost work time for specific pain conditions from the literature. Our study is more comprehensive because our measures of pain conditions, health care costs, and indirect costs (such as missed work days and hours and wages)
From page 305...
... Rather, we expected that persons suffering from these pain conditions would report having moderate or severe pain on the SF-12. Dependent Variables We used total expenditures as the dependent variable to predict the incremental costs of care for individuals with selected pain conditions compared with those without these conditions.
From page 306...
... For the analysis of indirect costs, we used the annual number of days of work missed because of pain conditions, the annual number of hours of work missed because of pain conditions, and hourly wages as dependent variables to predict the productivity loss associated with the different pain conditions. Variations in the annual number of days of work missed measure workers' decisions to use sick days.
From page 307...
... We developed three models to predict total health care expenditures and conduct sensitivity analyses for robustness, varying the degree to which we controlled for health status. In the first model, we measured pain with indicators for moderate pain, severe pain, joint pain, and arthritis.
From page 308...
... We converted the cost estimates into 2010 dollars using the medical care index of the CPI. We computed the impact of the incremental costs of selected pain conditions on the various payers for health care services.
From page 309...
... The prevalence estimates for selected pain conditions were 10 percent for moderate pain, 11 percent for severe pain, 33 percent for joint pain, 25 percent for arthritis, and 12 percent for functional disability. Adults with pain reported higher health care expenditures than adults without pain (see Table C-2)
From page 310...
... . The average incremental costs of health care for selected pain conditions ranged from $854 for joint pain to $3,957 for severe pain according to Model 1.
From page 311...
... The average hourly wage was $14.19. Among working-age adults, 9 percent reported having moderate pain, 10 percent severe pain, 31 percent joint pain, 21 percent arthritis, and 10 percent a functional disability.
From page 312...
... The average reduction in hourly wages for selected pain conditions ranged from $0.26 an hour for joint pain to $3.76 an hour for severe pain according to Model 1. Including functional disability in the models changed the estimates substantially for the other pain conditions -- from $0.05 an hour for joint pain to $1.66 an hour for severe pain.
From page 313...
... Sixth, we did not include other indirect costs -- lost tax revenue, costs for replacement workers, legal fees, and transportation costs for patients to reach providers. Finally, in our cost estimates we did not attempt to measure the psychological or emotional toll of chronic pain.
From page 314...
... We cannot estimate the impact of pain associated with musculoskeletal conditions or cancer. Third, our functional disability may include persons who do not have chronic pain.
From page 315...
... 2003. Lost productive time and cost due to common pain conditions in the US workforce.
From page 316...
... $4,475.23 $93.23 $4,291.41 $4,659.05 Any expenditures 0.85 0.00 0.84 0.86 Independent Variables SF-12 Measures No pain [reference] 0.79 0.00 0.78 0.80 Moderate pain 0.10 0.00 0.10 0.11 Severe pain 0.11 0.00 0.10 0.11 Other Measures of Pain Joint pain 0.33 0.01 0.32 0.35 Arthritis 0.25 0.01 0.24 0.26 Functional disability 0.12 0.00 0.11 0.12 Gender Male [reference]
From page 317...
... ; prescription drugs; and other (e.g., home health services, vision care services, dental care, ambulance services, and medical equipment)
From page 318...
... Interval] F-Test P-Value SF-12 Pain Measures No Pain $3,225.60 82.13 $3,063.67 $3,387.53 Moderate Pain 7,742.01 377.34 6,998.05 8,485.98 Difference 4,516.41 3,934.38 5,098.45 145.43 0.0000 Severe Pain 10,952.44 371.41 10,220.17 11,684.71 Difference 3,210.43 3,222.12 3,198.73 41.77 0.0000 Joint Pain No Joint Pain 3,055.17 82.20 2,893.01 3,217.24 Joint Pain 7,103.02 178.42 6,751.24 7,454.79 Difference 4,047.85 3,858.23 4,237.55 475.89 0.0000 Arthritis Pain No Arthritis 3,036.90 74.27 2,890.50 3,183.33 Arthritis 8,875.13 233.28 8,415.19 9,335.07 Difference 5,838.23 5,524.69 6,151.74 603.49 0.0000 Functional Disability No Disability 3,353.34 82.76 3,190.16 3,516.52 Disability 13,033.6 377.26 12,289.79 13,777.41 Difference 9,680.26 9,099.63 10,260.9 599.76 0.0000 SOURCE: Based on authors' calculations using the 2008 Medical Expenditure Panel Survey.
From page 319...
... (0.04) Functional Disability 0.73*
From page 320...
... Log-transformed generalized linear models were estimated for adults with positive expenditures. Model 2 includes functional disability in addition to all the other control variables.
From page 321...
... TABLE C-5 Total Incremental Costs of Medical Expenditures for Selected Pain Conditions (in millions of US$2010 and millions of persons) Condition Population Model 1 Model 2 Model 3 Moderate Pain 21.3 $45,716 $39,024 $39,646 Severe Pain 22.6 89,426 58,144 60,009 Joint Pain 70.3 60,054 48,280 45,630 Arthritis 53.4 65,917 61,071 59,292 Functional Disability 24.7 -- 93,529 88,680 Total $261,113 $300,048 $293,257 100.0 NOTES: Dollar amounts were adjusted for inflation as of 2010 using the Medical Care Inflation Index of the Consumer Price Index.
From page 322...
... Model 1 Model 2 Model 3 Out of Pocket 17 $44,381 $50,999 $49,845 Medicare 25 65,891 75,716 74,002 Medicaid 8 20,176 23,184 22,659 Private Insurance 43 112,260 128,999 126,079 Department of Veterans Affairs/TRICARE/ 3 7,322 8,413 8,223 Other Federal State/Other Public 1 2,960 3,401 3,324 Workers' Compensation 1 3,866 4,443 4,342 Other Sources 2 4,258 4,893 4,783 Total $261,113 $300,048 $293,257 100 NOTES: Dollar amounts were adjusted for inflation as of 2010 using the Medical Care Inflation Index of the Consumer Price Index. This analysis applied the distribution of total expenditures for nonin stitutionalized adults aged 18 or older to the total incremental costs due to persistent pain.
From page 323...
... 14.19 0.19 13.83 14.56 Any hours worked 0.81 0.00 0.80 0.82 Independent Variables SF-12 Measures No pain [reference] 0.81 0.00 0.82 0.79 Moderate pain 0.09 0.00 0.08 0.10 Severe pain 0.10 0.00 0.10 0.11 Other Measures of Pain Joint pain 0.31 0.01 0.30 0.33 Arthritis 0.21 0.01 0.20 0.22 Functional disability 0.10 0.00 0.09 0.10 Gender Male [reference]
From page 324...
... Wages were adjusted for inflation as of 2010 using the General Consumer Price Index. SOURCE: Based on the 2008 Medical Expenditure Panel Survey.
From page 325...
... F-Test P-Value No pain 1.48 0.07 1.34 1.61 Moderate pain 3.60 0.38 2.84 4.36 Difference 2.12 1.50 2.75 27.36 0.0000 Severe pain 6.21 0.50 5.22 7.20 Difference 2.61 2.37 2.84 18.44 0.0000 Joint Pain No joint pain 1.73 0.08 1.56 1.89 Joint pain 3.05 0.17 2.72 3.39 Difference 1.33 1.16 1.50 46.75 0.0000 Arthritis Pain No Arthritis 1.89 0.08 1.73 2.05 Arthritis 3.14 0.19 2.77 3.52 Difference 1.25 0.11 1.04 1.46 35.86 0.0000 Functional Disability No Disability 1.83 0.07 1.69 1.97 Disability 5.09 0.48 4.14 6.05 Difference 3.26 2.45 4.08 44.30 0.0000 SOURCE: Based on authors' calculations using the 2008 Medical Expenditure Panel Survey.
From page 326...
... F-Test P-Value No pain 1,697.45 10.75 1,676.25 1,718.64 Moderate pain 1,405.99 32.40 1,342.10 1,469.88 Difference 291.46 334.15 248.77 72.91 0.0000 Severe pain 980.56 32.66 916.17 1,044.95 Difference 425.43 425.93 424.93 89.81 0.0000 Joint Pain No joint pain 1,672.61 11.75 1,649.44 1,695.78 Joint pain 1,453.11 20.14 1,413.40 1,492.83 Difference 219.50 236.04 202.96 80.35 0.0000 Arthritis Pain No Arthritis 1,676.77 10.51 1,656.05 1,697.49 Arthritis 1,292.52 21.88 1,249.38 1,335.65 Difference 384.25 406.67 361.84 247.70 0.0000 Functional Disability No Disability 1,718.47 9.71 1,699.32 1,737.62 Disability 515.02 30.59 454.70 575.33 1462.73 Difference 1,203.45 –20.88 1,244.62 1,162.29 0.0000 SOURCE: Based on authors' calculations using the 2008 Medical Expenditure Panel Survey.
From page 327...
... Interval] F-Test P-Value No pain $15.22 0.22 $14.80 $15.65 Moderate pain 11.73 0.49 10.75 12.70 Difference 3.50 45.53 0.0000 Severe pain 7.58 0.33 6.93 8.24 Difference 4.14 3.83 4.46 46.40 0.0000 Joint Pain No joint pain 14.85 0.20 14.45 15.25 Joint pain 12.74 0.31 12.12 13.37 Difference 2.10 37.02 0.0000 Arthritis Pain No Arthritis 14.88 0.19 14.50 15.26 Arthritis 11.19 0.32 10.56 11.81 Difference 3.69 118.37 0.0000 Functional Disability No Disability 15.23 0.19 14.86 15.61 Disability 4.23 0.32 3.60 4.86 Difference 11.00 978.55 0.0000 NOTE: Wages were adjusted for inflation as of 2010 using the General Consumer Price Index.
From page 328...
... (0.11) Joint Pain 0.25*
From page 329...
... (0.08) Functional Disability 1.09*
From page 330...
... (0.01) Joint Pain 0.02 –0.02*
From page 331...
... (0.01) Functional Disability –1.98*
From page 332...
... (0.03) Joint Pain –0.04 –0.01 0.03 0.00 0.02 0.00 (0.06)
From page 333...
... (0.02) Functional Disability –1.95*
From page 334...
... TABLE C-15 Total Incremental Costs of Number of Days of Work Missed Because of Selected Pain Conditions (in millions of US$2010 and millions of persons) Conditions Population Model 1 Model 2 Model 3 Moderate Pain 14.1 $2,643 $2,541 $2,540 Severe Pain 15.6 6,476 7,330 7,196 Joint Pain 49.1 2,401 1,999 1,983 Arthritis 32.9 105 40 19 Functional Disability 14.9 -- 919 898 Total 69.8 $11,625 $12,728 $12,635 NOTES: Dollar amounts were adjusted for inflation as of 2010 using the General Consumer Price Index.
From page 335...
... TABLE C-17 Total Incremental Costs of Number of Hours of Work Missed Because of Selected Pain Conditions (in millions of US$2010 and millions of persons) Conditions Population Model 1 Model 2 Model 3 Moderate Pain 14.1 $11,380 $2,846 $2,618 Severe Pain 15.6 27,939 5,422 5,472 Joint Pain 49.1 19,750 5,550 5,296 Arthritis 32.9 37,472 20,530 20,090 Functional Disability 14.9 -- 61,495 61,742 Total 69.8 $96,542 $95,744 $95,217 NOTES: Dollar amounts were adjusted for inflation as of 2010 using the General Consumer Price Index.
From page 336...
... TABLE C-19 Total Indirect Costs Associated with Reductions in Wages Due to Selected Pain Conditions (in millions of US$2010 and millions of persons) Conditions Population Model 1 Model 2 Model 3 Moderate Pain 14.1 $35,795 $22,114 $21,791 Severe Pain 15.6 78,214 40,173 40,453 Joint Pain 49.1 19,959 3,709 4,293 Arthritis 32.9 56,657 30,340 29,396 Functional Disability 14.9 -- 130,029 129,577 Total 69.8 $190,625 $226,365 $216,924 NOTES: Dollar amounts were adjusted for inflation as of 2010 using the General Consumer Price Index.
From page 337...
... SOURCE: Based on authors' calculations using the 2008 Medical Expenditure Panel Survey.


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