SEATTLE, Washington—The 65% increase in expenditures for back and neck problems in the US between 1997 and 2005 did not produce commensurate improvements in physical functioning, ability to work, or school or social limitations, according to a new study in the February 13, 2008 issue of Journal of the American Medical Association.¹

"Despite rapidly increasing medical expenditures from 1997 to 2005, there was no improvement over this period in self assessed health status, functional disability, work limitations, or social functioning among respondents with spine problems," conclude researchers led by Brook I. Martin, MPH, of the center for cost and outcomes research at the University of Washington in Seattle.

High costs, few benefits

In an interview with MSKreport.com, Martin said, "As a society, we are spending a lot of money on this problem and not seeing a reduction in the level of physical functioning. We need to make sure our investments are commensurate with health improvement."

The challenge, he added, is that "health outcomes and interventions vary dramatically. Some patients will improve from spine surgery and others may not, but we don't have good studies knowing who will benefit and who will not in advance."

The researchers analyzed data spanning 1997 to 2005 from the Medical Expenditure Panel Survey. Of 23,045 respondents in 1997, there were 3139 who reported spine problems. Of 22,258 respondents in 2005, there were 3187 who reported spine problems. This translated into a 20.7% increase in the proportion of people with back or neck problems who self-reported physical functioning limitations.

Money matters

Expenditures were higher in each year for those with spine problems than for those without, the study showed. In 1997, the average age- and sex-adjusted medical costs for individuals with spine problems was $4695 compared with $2731 among those without spine problems (inflation adjusted to 2005 dollars). By contrast, the average age- and sex-adjusted medical expenditures among respondents with spine problems was $6096 in 2005 compared with $3516 among those without spine problems. This translated into a 65% rise in the total national expenditure of adults with spine problems, which was greater than that seen with overall health expenditures, the study found.

The prescription medications proportion of the total expenditures increased more dramatically during the study period than other major services. Specifically, nationally estimated pharmacy expenses for spine problems increased from $7.3 billion to $21.2 billion during the time frame studied. In 1997, drugs comprised 14% of the total expenditures. By contrast, prescription drug costs accounted for 23% of total expenditures in 2005.

Most of the difference observed in inflation-adjusted expenditures between those with and without spine problems in 2005 was due to outpatient services (36%) and inpatient services (28%), the study showed; smaller proportions were due to prescription medications (23%); emergency department visits (3%); and home health, dental, and other expenses (10%).

The average expenditures for people with spine problems was 73% greater than that of their counterparts without spine problems across all years studied. The researchers point out that only expenditures for heart disease and stroke were substantially higher than those for spine problems.

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