A cost-of-illness study of back pain in The Netherlands

Maurits W. van Tulder*, Bart W. Koes, Lex M. Bouter

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

607 Citations (Scopus)


In this study we estimated the costs of back pain to society in The Netherlands in 1991 to be 1.7% of the GNP. The results also show that musculoskeletal diseases are the fifth most expensive disease category regarding hospital care, and the most expensive regarding work absenteeism and disablement. One-third of the hospital care costs and one-half of the costs of absenteeism and disablement due to musculoskeletal disease were due to back pain. The total direct medical costs of back pain were estimated at US$367.6 million. The total costs of hospital care due to back pain constituted the largest part of the direct medical costs and were estimated at US$200 million. The mean costs of hospital care for back pain per case were US$3856 for an inpatient and US$199 for an outpatient. The total indirect costs of back pain for the entire labour force in The Netherlands in 1991 were estimated at US$4.6 billion; US$3.1 billion was due to absenteeism and US$1.5 billion to disablement. The mean costs per case of absenteeism and disablement due to back pain were US$4622 and US$9493, respectively. The indirect costs constituted 93% of the total costs of back pain, the direct medical costs contributed only 7%. It is therefore concluded that back pain is not only a major medical problem but also a major economical problem.

Original languageEnglish
Pages (from-to)233-240
Number of pages8
Issue number2
Publication statusPublished - Aug 1995

Bibliographical note

Funding Information:
The authors wish to thank Mr. G. Franssen (RNH), Mrs. R.R.M. de Groot (SIG), Mr. S.P. Schouten (SVr), Mr. J.W. Nool (SVr), Mr. L.D.J. Maljers (GAK), and Mr. E. Debougnoux (LIASS-Ziektekostenverzekerin-gen) for providing data, and Mr. H. Vondeling for his critical remarks. This study was supported by a grant of The Netherlands Medical Insurance Board.


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