The economic burden of shoulder pain awaiting public orthopaedic care

Background: Shoulder pain is the second to third most prevalent musculoskeletal disorder and is frequently referred to public orthopaedic services, where patients often face long waiting lists. An understanding of the societal economic burden of shoulder pain in patients awaiting orthopaedic care is needed to inform public health expenditure and the economic impact of new services. Little is presently known of the indirect costs of shoulder pain, such as personal support costs and work related productivity loss. Furthermore the economic burden of shoulder pain awaiting orthopaedic care has not previously been reported.

Purpose: To estimate the economic burden of shoulder pain from a societal perspective, in patients on a waiting list for public hospital orthopaedic care.

Methods: Information relating to the cost of shoulder pain was gathered from 277 patients on an Australian public hospital orthopaedic waiting list. Demographic and clinical information was recorded and a variety of direct and indirect cost information obtained via patient-reported questionnaire using a three-month recall period. Work-related absenteeism and productivity loss at work was collected with two tools; the Work Productivity and Activity Index (WPAI), and the Work Limitations Questionnaire. Indirect costs were assigned through the human capital approach using wage rates for employed patients, and the Australian minimum wage for personal and domestic support items. All costs were converted to per day figures to obtain a daily societal economic burden of shoulder pain.

Results: For shoulder patients on an orthopaedic waiting list we estimate average per day direct healthcare costs (appointments, investigations, care, medicines) at AUD$5.82 (SD 4.05), with patient costs for related time and travel at AUD$0.65 (SD 0.98). Average per day indirect cost estimates were AUD$9.61 (SD19.93) for personal and domestic support, and AUD$40.84 (SD 36.08) for WPAI reported overall work productivity loss due to absenteeism and presenteeism. This equates to an overall societal cost of AUD$16.08 per patient per day, increasing to AUD$56.92 for employed patients.

Conclusion: We estimate the cost to society per case of shoulder pain on an orthopaedic waiting list to be AUD$16.08 per day, increasing to AUD$56.92 per day for employed patients when the additional burden of work productivity loss is considered.

Implications: Considering the volume of shoulder pain patients on public orthopaedic waiting lists, the national economic burden of shoulder pain in patients awaiting orthopaedic care is likely to be hundreds of millions of dollars annually. This highlights the importance of new models of care that improve access for patients.

Funding acknowledgements: In kind support was provided by Gold Coast Hospital and Health Service.

Ethics approval: Gold Coast Hospital and Health Service Human Research Ethics Committee, NHMRC code EC00160 (HREC/12/QGC/30; SSA/12/QGC/97), and Griffith University Human Research Ethics Committee (MED/23/13/HREC).