Incremental healthcare costs for chronic pain in Ontario, Canada – a population-based matched cohort study of adolescents and adults using administrative data

Little is known about the economic burden of chronic pain, and how chronic pain affects healthcare utilization. We aimed to estimate the annual per-person incremental medical cost and healthcare utilization for chronic pain in the Ontario population from the perspective of the public payer. We performed a retrospective cohort study using Ontario healthcare databases and the electronically linked Canadian Community Health Survey (CCHS) from 2000 to 2011. We identified subjects aged 12 years and above from the CCHS with chronic pain and closely matched them to individuals without pain using propensity score matching methods. We used linked data to determine mean one-year per-person healthcare costs and utilization for each group and mean incremental cost for chronic pain. All costs are reported in 2014 Canadian dollars.After matching we had 19,138 pairs of CCHS respondents with and without chronic pain. The average age was 55 years (SD 18) and 61% were female. The incremental cost to manage chronic pain was $1,742 per person (95% CI 1,488 – 2,020), 51% more than the control group. The largest contributor to the incremental cost was hospitalization ($514, 95% CI $364 to $683). Incremental costs were highest in those with severe pain ($3,960, 95% CI $3,186 to $4,680) and those with most activity limitation ($4,365, (95% CI $3,631 – $5,147).The per-person cost to manage chronic pain is substantial and more than 50% higher than a comparable patient without chronic pain. Costs are higher in people with more severe pain and activity limitations.