OVERVIEW OF THE ECONOMIC BURDEN OF MUSCULOSKELETAL PAIN IN CHILDREN AND ADOLESCENTS: A SYSTEMATIC REVIEW WITH META-ANALYSIS

Background

Some studies suggest a high economic burden among children and adolescents with musculoskeletal pain. However, there is no summary in the literature to understand the scenario of the economic burden of musculoskeletal pain in this population.

Objectives

This study aimed to synthesize the economic burden of musculoskeletal pain in children and adolescents.

Methods

We conducted electronic searches on MEDLINE, EMBASE, CINAHL, EconLit, NHS-EED, and HTA databases from inception to July/2022. We included cost-of-illness studies that estimated healthcare, patient/family, lost productivity, and/or societal costs in children and adolescents (up to 24 years old) with musculoskeletal pain. The primary outcome was cost, and the results were grouped by the same cost categories (i.e., healthcare, patient/family, lost productivity, societal), conditions, time horizon, and cost range for musculoskeletal pain. All costs were inflated to the same reference year (2021) and converted to American Dollars ($). The risk of bias the included studies was assessed using a checklist based on the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement.

Results

We included 45 cost-of-illness studies (n=665,623). Thirty-eight studies (84.4%) were conducted in high-income countries, six (13.3%) in upper-middle-income countries, and one (2.2%) in lower-middle-income countries. Regarding the risk of bias assessment, 75.5% (n=34 studies) clearly presented the unit costs, and 69% (n=31 studies) presented the expenditure data transparently. In contrast, more than half of the studies did not include productivity costs or sensitivity analysis. The annual healthcare costs ranged from $143 to $41,379 per child/adolescent (n=22 studies). The annual patient/family costs ranged from $287 to $27,972 per child/adolescent (n=9 studies). The annual lost productivity costs ranged from $124 to $4,671 per child/adolescent (n=7 studies). The annual societal costs ranged from $1,095 to $69,351 per child/adolescent (n=9 studies). Children and adolescents with juvenile idiopathic arthritis and musculoskeletal pain had higher annual incremental healthcare costs than children and adolescents without these conditions (mean difference: $3,800, 95% confidence interval [CI]: 50 to 7,550; mean difference: $740, 95% CI: 470 to 1,010, respectively).

Conclusion

The annual economic burden of musculoskeletal pain per child and adolescent ranged from $124 to $69,351.

Implications

This systematic review summarizes the evidence of the economic burden of musculoskeletal pain in children and adolescents. The results of this study showed that the musculoskeletal pain in children and adolescents seems to represent an important part of the economic burden in children's health. However, our estimates span a large range for all cost categories, making it difficult to interpret the economic burden in this population.