Estimating the direct healthcare utilisation and cost of musculoskeletal pain among people with comorbidity: a retrospective electronic health record study.

Objective: To investigate the impact of pre-existing painful musculoskeletal conditions on healthcare utilisation and costs among patients with five common conditions: acute coronary syndrome (ACS), stroke, cancer, dementia and pneumonia. Methods: Using primary and secondary care services data from electronic health records, negative binomial regression model was used to compare resource use while two-part model was used to compare costs across the five conditions, between those with and without a pre-existing musculoskeletal pain. Results: The study included 760,792 patients (144,870 with ACS, 121,208 with stroke, 231,702 with cancer, 134,638 with dementia, and 128,374 with pneumonia) in the complete-case analysis. Pre-existing musculoskeletal pain had an incident rate ratio of above one for most healthcare resources over the follow-up period and an adjusted additional mean cumulative total healthcare costs per patient of £674.59 (95%CI 570.30 to 778.87) for ACS; £613.34 (95%CI 496.87 to 729.82) for stroke; £459.26 (95%CI 376.60 to 541.91) for cancer; and £766.23 (95%CI 655.06 to 877.39) for dementia over five years after diagnosis; and £200.85 (95%CI 104.16 to 297.55) for pneumonia over one year after diagnosis compared to those without musculoskeletal pain. Conclusion: This study highlights that individuals with painful musculoskeletal conditions have a higher healthcare utilisation and costs than those without a painful musculoskeletal condition. Given the high occurrence of musculoskeletal pain in patients with other conditions, effective management strategies are needed to reduce the burden on healthcare resources.