Cost-of-illness of neck pain in The Netherlands in 1996

Jeroen A.J. Borghouts*, Bart W. Koes, Hindrik Vondeling, Lex M. Bouter

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

343 Citations (Scopus)


The prevalence of neck pain in the general population ranges from 10 to 15%. The complaints can result in substantial medical consumption, absenteeism from work and disability. In this study we investigated the costs of neck pain in the Netherlands in 1996 to assess the financial burden to society. The study was based on prevalence data. Data sources included national registries, reports of research institutes and health care authorities. Direct health care costs were estimated for hospital care, general practice care and paramedical care. These costs were calculated using fees. Calculation of indirect costs (absenteeism and disability) was based on the Human Capital Method (HCM). As an alternative approach the Friction Cost Method (FCM) was used. The total cost of neck pain in The Netherlands in 1996 was estimated to be US $686 million. The share of these costs was about 1% of total health care expenditures and 0.1% of the Gross Domestic Product (GDP) in 1996. Direct costs were $160 million (23%). Paramedical care accounted for largest proportion of direct costs (84%). When applying the HCM for calculating indirect costs, these costs amounted to $527 million (77%). The total number of sick days related to neck pain were estimated to be 1.4 million with a total cost of $185.4 million in 1996. Disability for neck pain accounted for the largest proportion (50%) of the total costs related to neck pain in 1996 ($341). When applying the FCM for calculating the indirect costs, these costs were reduced to $96 million. The costs related to neck pain in 1996 in The Netherlands were substantial. Some caution should be taken in interpretation, as a number of assumptions had to be made in order to estimate the total costs. The cost structure shown in this study, with high indirect costs, has also been found in other studies. From an economical point of view it seems to be important to prevent patients from having to take sick leave and disability. One way in achieving this goal is to develop and investigate more effective treatments for acute neck pain, in order to prevent patients developing chronic pain and disability. Another option is to protect chronic patients from sick leave and disability by careful management. Thus, also in the area of direct medical costs, there may be room for cost savings by stimulating and improving cost-efficiency and cost-effectiveness of the (para)medical care. In order to deal with the lack of specific disease information, more detailed information of medical consumption, sick leave and disability is required for future cost analysis. Copyright (C) 1999 International Association for the Study of Pain.

Original languageEnglish
Pages (from-to)629-636
Number of pages8
Issue number3
Publication statusPublished - 1 Apr 1999

Bibliographical note

Funding Information:
The authors would like to thank Dr. R.R.M. de Groot (SIG), Mr J.L. de Loof (LISV), Ms D. Jeurissen (LISV), Dr. D. de Bakker (NIVEL), Ms J. Engel (medical administration AZVU), department of medical encoding and the COTG for providing data and information, and Dr. M.W. van Tulder for his remarks. This study was supported by research grant 940-31-032 and 940-31-037 from the Dutch Scientific Research Foundation (NWO), Pain-Program, The Hague, The Netherlands.


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