The economic burden of low back pain in KwaZulu-Natal, South Africa: a prevalence-based cost-of-illness analysis from the healthcare provider’s perspective

ABSTRACT Background Globally, low back pain (LBP) is associated with high economic costs due to healthcare expenditure and production loss. There is lack of evidence regarding this in low-and-middle-income-countries (LMICs), including South Africa. Thus, the study aimed to determine the economic burden of LBP from the providers perspective. Methods We used a retrospective prevalence-based cost-of-illness methodology to estimate the direct medical cost of LBP. Direct medical costs constituted costs associated with healthcare utilisation in inpatient care, outpatient care, investigations, consultations, and cost of auxiliary devices. We used diagnostic-specific data obtained from hospital clinical reports. All identifiable direct medical costs were estimated using a top-down approach for costs associated with healthcare and a bottom-up approach for costs associated with inpatient and outpatient care. Results The prevalence of CLBP was 24.3% (95% CI: 23.5 – 25.1). The total annual average direct medical costs associated with LBP was US$5.4 million. Acute LBP and CLBP contributed 17% (US$0.92 million) and 83% (US$4.48 million) of the total annual average direct medical cost, respectively. The per patient total annual average direct medical cost for acute LBP and CLBP were US$99.43 and US$1,516.67, respectively. The total average cost of medication per patient for acute and CLBP were US$82.53 and US$320.31, respectively. Overall, the outpatient care costs contributed the largest share (38.9%, US$2.10 million) of the total average direct medical cost, 54.9% (US$1.15 million) of which was attributed to NSAIDs and only 10% (US$0.21 million) of the total outpatient cost was due to rehabilitation. The total average cost of diagnostic investigations was estimated at US$831,595.40, which formed 15.4% of the average total cost. Conclusion The economic burden of LBP is high in South Africa. Majority of costs were attributed to CLBP. Action should be taken to develop culturally validated cost-effective prevention measures to mitigate the burden of LBP.