C. Melo1, V. Santos1, G. Miyamoto1,2, S. Kamper3,4,5, C. Williams3,6,7, T. Yamato1,4,3
1Universidade Cidade de São Paulo, Programa de Mestrado e Doutorado em Fisioterapia, São Paulo, Brazil, 2Vrije Universiteit Amsterdam, Department of Health Sciences, Faculty of Science, Amsterdam, Netherlands, 3Center for Pain, Health, and Lifestyle (CPHL), New Lambton Heights, Australia, 4The University of Sydney, School of Health Sciences, Faculty of Medicine and Health, Sydney, Australia, 5Nepean Blue Mountains Local Health District, NSW, Australia, 6University of Newcastle, School of Medicine and Public Health, Hunter Medical Research Institute, Newcastle, Australia, 7Hunter New England Local Health District, Hunter New England Population Health, Wallsend, Australia
Background: Chronic pain is extremely prevalent and it should be noted as major health concerning among children and adolescents. Musculoskeletal pain in children and adolescents implies in an economic burden for society and the family due to healthcare expenditures and parental productivity loss. Although some studies suggest a high economic burden among children and adolescents, there is no summary in the literature to understand the scenario of the economic burden of musculoskeletal pain in children and adolescents.
Purpose: To conduct a systematic review of the peer-reviewed literature to identify the economic burden of musculoskeletal pain in children and adolescents.
Methods: We searched on MEDLINE, Embase, CINAHL, EconLit, NHSEED and HTA from inception to September 2020 without language restrictions. We searched any studies design that have estimated healthcare costs, lost productivity or patient/family costs as an economic burden in children and adolescents with musculoskeletal conditions in peer-review literature. We included studies with children and adolescents up to 19 years old (or studies that reported this age group separately) with musculoskeletal pain conditions. The outcome of interested was the costs measured. We assessed the risk of bias of individual studies using the checklist developed by Gheorghe et al. (2018) based in Consolidated Health Economic Evaluation Reporting Standards (CHEERS) Statement. We collected data from multiple studies with different metric, settings, countries and context. Thus, a narrative summary was performed including the cost estimated and their precision.
Results: The search yielded 12,923 titles/abstract once duplicate were removed. Nine studies met the inclusion criteria. Studies were conducted in the United States (4 = 44,4%), Germany (4 = 44,4%) and United Kingdom (1 = 11,1%). The total sample of the studies was 661,718 children and adolescents. The age of sample ranged from 0 to 17 years. The risk of bias of studies was generally moderate. The estimated values were adjusted in dollars. The healthcare costs were very heterogeneous between studies. Annually, the total costs per patient for treatment of musculoskeletal pain ranged from $1,000 to $16,527 dollars. In addition, pediatric pain condition accounted incremental healthcare expenditures of $1339 dollars. In Germany, back disorders in children and adolescents accounted approximately $116 billion dollars for health insurers at one year. In the United States, pediatric pain has been associated with an additional $11.8 billion dollars in healthcare expenditures. The annual economic burden in the societal perspective was $4896 million dollars and $19.5 billion dollars in the United Kingdom and United States, respectively.
Conclusion(s): Healthcare costs for treatment of musculoskeletal pain causes high economic burden for patient, insurance company and society. Interventions to treat and prevent musculosketal pain in children and adolescents are necessary aiming at decrease costs.
Implications: The results we found may inform policy makers to allocate resources for managing musculoskeletal pain conditions in children and adolescents. Future studies must evaluate treatments to reduce disabling musculoskeletal pain and its economic burden. In addition, we recommend to assess the cost-effectiveness of the healthcare interventions to musculoskeletal pain in children and adolescents.
Funding, acknowledgements: This study is supported by the Sao Paulo Research Foundation (FAPESP, process number 2017/17484-1; process number 2020/06864-0; process number 2019/12049-0)
Keywords: musculoskeletal pain, children and adolescents, economic burden
Topic: Musculoskeletal
Did this work require ethics approval? No
Institution: Universidade Cidade de São Paulo
Committee: N/A
Reason: This study is a systematic review of cost-of-illness
All authors, affiliations and abstracts have been published as submitted.
