Low back pain should be considered a health and research priority in Brazil: Lost productivity and healthcare costs between 2012 to 2016

BackgroundLow Back Pain (LBP) is associated with an increase in disability-adjusted life years, and increased risk of disability retirement and greater absenteeism in Brazil. Hence, evidence on healthcare and lost productivity costs due to LBP is of utmost importance to inform decision-makers.MethodsCost-of-illness study with top-down approach, and societal perspective. We extracted data from National databases, considering the period 2012–2016. Outpatient expenses included clinical, surgical, diagnosis, orthosis/prosthetics, and complementary actions. Inpatient care expenses included hospital and professional services, intensive care unit, and companion stay. For productivity losses, duration of work absence and associated information (work-related and non-work-related; value of the sickness absence benefit; age; gender; and economic activity) were analyzed. Lost productivity costs were calculated multiplying the absence from work (days) by the daily-benefit.ResultsThe societal costs amounted to US$ 2.2 billion, and productivity losses represented 79% of the costs. Total healthcare expenses were estimated to US$ 460 million. We found more than 880,000 diagnostic images. Individuals with LBP were in total 59 million days absent from work between 2012–2016. The mean lost days absent from work per person, for each year investigated was, respectively, 88; 84; 83; 87; and 100. Men were more days absent from work than women. In addition, rural workers presented greater absence from work compared to other professional activities.ConclusionHealthcare expenses and lost productivity costs due to LBP were substantial, hence, there is a need for improvement of health services and policies to deal with this increasing burden of illness. We found an extensive use of diagnostic imaging, which is rather discouraged by clinical guidelines. We assume that men were experiencing high levels of back pain disability compared with women, as they presented greater absenteeism and higher lost productivity costs.

【研究背景】下腰痛（Low Back Pain, LBP）与巴西人群的伤残调整寿命年（disability-adjusted life years）升高、伤残退休风险增加以及缺勤率上升密切相关。因此，明确下腰痛相关的医疗支出与生产力损失成本，对决策者制定公共卫生政策具有至关重要的参考意义。
【研究方法】本研究采用自上而下法与社会视角开展疾病成本分析，数据提取自巴西国家数据库，研究时段为2012年至2016年。门诊费用涵盖临床诊疗、外科治疗、诊断检查、矫形器/假肢配置及辅助诊疗项目；住院医疗费用包含住院与专业服务费用、重症监护费用以及陪护费用。针对生产力损失，本研究分析了缺勤时长及相关关联信息，包括工作相关与非工作相关缺勤、病假津贴标准、年龄、性别及经济活动类型。生产力损失成本通过缺勤天数与日津贴的乘积计算得到。
【研究结果】本次研究的社会总成本达22亿美元，其中生产力损失占总成本的79%；医疗总支出约为4.6亿美元。研究共涉及超过88万例诊断影像检查。2012年至2016年间，下腰痛患者的总缺勤时长累计达5900万天。各调查年份的人均年均缺勤天数分别为88天、84天、83天、87天和100天。男性缺勤天数显著多于女性；此外，农村劳动者的缺勤天数高于其他职业群体。
【研究结论】下腰痛相关的医疗支出与生产力损失成本十分高昂，因此亟需完善医疗服务体系与相关公共政策，以应对这一日益加重的疾病负担。本研究发现诊断影像检查的使用规模极大，而该做法与临床指南的推荐导向相悖。鉴于男性的缺勤率更高、生产力损失成本更大，我们推测相较于女性，男性下腰痛相关的伤残程度更为严重。