Big spending on bad backs, osteoarthritis

3 minute read

At an estimated $14 billion, musculoskeletal conditions attract the most spending across the Australian health system.

Musculoskeletal conditions attract the most spending across the Australian health system, over and above the costs of cardiovascular disease and cancer, new AIHW data shows.

An estimated $14 billion or 10.3% of total health spending in 2018–19 was billed to back pain and other musculoskeletal conditions, according to the latest Australian Institute of Health and Welfare (AIHW) disease expenditure report, published this week.

“The report highlights the urgent need to develop efforts to reduce unnecessary care for musculoskeletal conditions,” said Gustavo Machado, a physiotherapist at the University of Sydney’s Institute of Musculoskeletal Health.

The AIHW cost estimates include money spent in the healthcare sector on treatments, medications, medical imaging, pathology, primary care, hospital spending, outpatient clinics and allied health services – used to treat, manage and prevent illness.

“Cardiovascular disease and cancer cause the greatest burden in terms of death, but when judged by disability musculoskeletal conditions are the top contributors to disease burden in Australia,” Dr Machado said.

One in four knee or hip replacement surgeries for people with osteoarthritis are unnecessary while spinal fusion surgery is an overdone procedure in Australia, and both are key drivers of musculoskeletal healthcare costs, he said.

Hospitalisations for musculoskeletal conditions have also increased for the tenth consecutive year, to a record high in 2017–18, lasting 9 days on average and costing about $15,000 per admission, he added.

“Many of these hospitalisations could have been avoided and safely managed in the community,” Dr Machado said.

In the 2018–19 AIHW data, musculoskeletal disorders ranked as the most expensive category ($4.9 billion) for patients admitted to private hospitals, where nearly three-quarters of knee or hip replacements take place, Dr Machado said.

Adding to the health burden are the indirect costs of life-long musculoskeletal conditions, including the mental toll of disability – one factor which puts musculoskeletal conditions in the top 5 disease groups causing the greatest loss of healthy life second after cancer, and on par with cardiovascular diseases and mental and substance use disorders. 

The lost productivity, reduced employment and early retirement due to back pain and other musculoskeletal conditions costs around $11.7 billion a year, based on previous estimates, Dr Machado said.

Professor Rachelle Buchbinder, a rheumatologist and epidemiologist at Monash University in Melbourne, said healthcare spending on musculoskeletal conditions may well exceed AIHW estimates because falls could also include musculoskeletal complications such as fractures.

Falls and osteoarthritis had the highest spending for specific conditions in 2018–19 after tooth decay, with $4.3 billion spent on fall injuries alone, the AIHW reported. Cancer and chronic diseases such as cardiovascular diseases were most costly in the over 50s.

Professor Buchbinder agreed that some of the high costs for musculoskeletal conditions would be due to unwarranted and low-value care, such as the overuse of imaging, surgery and opioids for back pain.

Lowering costs and improving care could be achieved by focusing on preventive strategies and self-managed care, she said.

“There is an urgent need to consider the components of the costs that represent low-value care and intervene to reduce these,” Professor Buchbinder said. Otherwise, people will miss out on high-quality care, and the carbon footprint of the healthcare system – which currently represents 7% of Australian emissions – is unlikely to shrink, she added.


AIHW Disease expenditure in Australia 2018-19, published Aug 25, 2021

AIHW 2018 Burden of Disease Study 2018, published Aug 18, 2021

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