Costs of shoulder pain in primary care consulters: a prospective cohort study in The Netherlands

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Abstract

Background

Shoulder pain is common in primary care, and has an unfavourable outcome in many patients. Information on the costs associated with health care use and loss of productivity in patients with shoulder pain is very scarce. The objective of this study was to determine shoulder pain related costs during the 6 months after first consultation in general practice

Methods

A prospective cohort study consisting of 587 patients with a new episode of shoulder pain was conducted with a follow-up period of 6 months. Data on costs were collected by means of a cost diary during 6 months.

Results

84% of the patients completed all cost diaries. The mean consumption of direct health care and non-health related care was low. During 6 months after first consultation for shoulder pain, the mean total costs a patient generated were €689. Almost 50% of this total concerned indirect costs, caused by sick leave from paid work. A small proportion (12%) of the population generated 74% of the total costs.

Conclusion

The total costs in the 6 months after first consultation for shoulder pain in primary care, mostly generated by a small part of the population, are not alarmingly high.

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Most cited references 19

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How should cost data in pragmatic randomised trials be analysed?

S. Thompson, Tracie Barber (2000)

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Shoulder disorders in general practice: prognostic indicators of outcome.

B Koes, W Deville, Robrecht van der Wel … (1996)

Shoulder pain is common in primary health care. Nevertheless, information on the outcome of shoulder disorders is scarce, especially for patients encountered in general practice. To study the course of shoulder disorders in general practice and to determine prognostic indicators of outcome. For this prospective follow-up study, 11 Dutch general practitioners recruited 349 patients with new episodes of shoulder pain. The participants filled out a questionnaire at presentation and further ones after 1, 3, 6 and 12 months; these contained questions on the nature, severity and course of the shoulder complaints. The association between potential prognostic indicators and the status of shoulder complaints (absence or presence of symptoms) was evaluated after one and 12 months of follow-up. After one month, 23% of all patients showed complete recovery; this figure increased to 59% after one year. A speedy recovery seemed to be related to preceding overuse or slight trauma and early presentation. A high risk of persistent or recurrent complaints was found for patients with concomitant neck pain and severe pain during the day at presentation. A considerable number of patients (41%) showed persistent symptoms after 12 months. It may be possible to distinguish patients who will show a speedy recovery from those with a high risk of long-standing complaints by determining whether there is a history of slight trauma or overuse, an early presentation or an absence of concomitant neck pain.

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Standardisation of costs: the Dutch Manual for Costing in economic evaluations.

Jan Oostenbrink, Marc Koopmanschap, Frans F. H. Rutten (2002)

The lack of a uniform costing methodology is often considered a weakness of economic evaluations that hinders the interpretation and comparison of studies. Standardisation is therefore an important topic within the methodology of economic evaluations and in national guidelines that formulate the formal requirements for studies to be considered when deciding on the reimbursement of new medical therapies. Recently, the Dutch Manual for Costing: Methods and Standard Costs for Economic Evaluations in Health Care (further referred to as "the manual") has been published, in addition to the Dutch guidelines for pharmacoeconomic research. The objectives of this article are to describe the main content of the manual and to discuss some key issues of the manual in relation to the standardisation of costs. The manual introduces a six-step procedure for costing. These steps concern: the scope of the study;the choice of cost categories;the identification of units;the measurement of resource use;the monetary valuation of units; andthe calculation of unit costs. Each step consists of a number of choices and these together define the approach taken. In addition to a description of the costing process, five key issues regarding the standardisation of costs are distinguished. These are the use of basic principles, methods for measurement and valuation, standard costs (average prices of healthcare services), standard values (values that can be used within unit cost calculations), and the reporting of outcomes. The use of the basic principles, standard values and minimal requirements for reporting outcomes, as defined in the manual, are obligatory in studies that support submissions to acquire reimbursement for new pharmaceuticals. Whether to use standard costs, and the choice of a particular method to measure or value costs, is left mainly to the investigator, depending on the specific study setting. In conclusion, several instruments are available to increase standardisation in costing methodology among studies. These instruments have to be used in such a way that a balance is found between standardisation and the specific setting in which a study is performed. The way in which the Dutch manual tries to reach this balance can serve as an illustration for other countries.

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Author and article information

Journal

Journal ID (nlm-ta): BMC Musculoskelet Disord

Title: BMC Musculoskeletal Disorders

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2474

Publication date Collection: 2006

Publication date (Electronic): 1 November 2006

Volume: 7

Page: 83

Affiliations

[1 ]Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands

[2 ]Department of Allied Health Care Research, Amsterdam School of Allied Health Care Education, The Netherlands

[3 ]Care and Public Health Research Institute, Maastricht University, The Netherlands

[4 ]Department of Health Economics and Health Technology Assessment, Institute of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands

[5 ]Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands

[6 ]Primary Care Musculoskeletal Research Centre, Keele University, Keele Staffordshire, UK

Article

Publisher ID: 1471-2474-7-83

DOI: 10.1186/1471-2474-7-83

PMC ID: 1635047

PubMed ID: 17078883

SO-VID: 408d9900-ddd1-4d78-9fab-7995b5bce6bc

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Costs of shoulder pain in primary care consulters: a prospective cohort study in The Netherlands

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Abstract

Background

Methods

Results

Conclusion

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Orthopedics

Most cited references 19

How should cost data in pragmatic randomised trials be analysed?

Shoulder disorders in general practice: prognostic indicators of outcome.

Standardisation of costs: the Dutch Manual for Costing in economic evaluations.

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