by Matt Breckons
The DEEP Study was carried out by a team of researchers at Newcastle University with the aim of gaining a better understanding of the costs involved in managing persistent orofacial pain and how care pathways could be improved for people with the condition.
Persistent orofacial pain (POFP) refers to a group of conditions which cause pain in the face or mouth and do not originate in the teeth. Previous studies have suggested that health professionals find it hard to manage POFP and that consequently many patients have difficulty obtaining a diagnosis and effective treatment for the condition
Qualitative research has highlighted the severity and impact of the pain that people experience and how the current care pathway often results in people spending extended periods of time with unmanaged pain.
The DEEP study was funded by the National Institute for Health Research (NIHR) to investigate care pathways for people with POFP in order to gain an understanding of how these could be improved from a health service and a patient perspective i.e. how care could be done better and cost less to the health service, the patient, and the economy.
Published data from the DEEP study has described the health service costs associated with POFP and has shown that people with higher levels of pain are more likely to incur higher costs [1]. The data also showed that costs of treatment are lower than appointment costs, with patients likely to attend multiple appointments with doctors and dentists. However, this does not tell the whole story as we know that the financial impact of long-term conditions can be further reaching than health service costs.
In the UK the way the health service is funded means that patients do not incur the full cost of treatment, however this does not mean that there are no financial consequences to illness. For example, in 2014 Macmillan Cancer Support produced a report titled ‘Cancer’s hidden price tag’, detailing how people living with cancer, experienced a loss of earnings which, along with extra costs such as travel, parking and increased day to day living expenses, left 4 out of 5 people £570 worse off every month [2].
Taking an employer’s perspective, a commonly used example of costs is that of back pain. Previous research attempting to quantify the costs to the UK economy suggested that up to £3500 million per year is incurred due to the lost productivity of people experiencing back pain [3].
Therefore similar questions remain about POFP. Our published findings to date suggest that patients are likely to attend multiple medical and dental appointments but we don’t understand the financial impact of these on patients (i.e. patients’ out of pocket costs). Similarly it is important to understand if lost productivity costs employers money (i.e. indirect costs).
We collected data every 6 months for 2 years from a group of 200 people with POFP. We asked people what type of appointments, and how many, they attended as well as how they travelled there, if anyone went with them and what activity they would have been doing instead. We asked people about other costs due to their orofacial pain such as prescription charges, over the counter medication, private treatments or any other outgoings they attributed to their pain. If people were employed we asked them how many days they were off work because of their pain, or if they went to work whilst in pain we asked how often that happened and if they felt they did less work (and how much less); this information allowed us to estimate the cost of lost productivity. We also asked people to complete a questionnaire which asked about the severity of their pain as well as ‘pain related disability’, the amount that people’s lives are impacted by pain.
Our findings indicated that, on average, patients in the study were out of pocket by more than £300 in a 6 month period. People with more severe pain-related disability (measured using the Graded Chronic Pain Scale) were likely to be the most out of pocket.
When it came to employer costs, those who worked reported, on average, missing 2 days of work which was likely to cost employers just over £170 over 6 months in occupational sick pay. However our data indicated that, rather than stay off work, people were more likely to attend work while experiencing pain – for an average of nearly 35 days, during which time they reported that they were able to work at about 80% of their usual quality and quantity which corresponded to more than £1000 in lost productivity. Again, those with more severe pain were likely to cost their employers more.
Taken together, the figures from this study suggest that POFP could cost the economy more than £3000 a year per person experiencing it. Given that this is in addition to costs to the NHS and that people may experience POFP for a number of years, these figures highlight the importance of effective management of POFP in order to limit these costs.
One previous suggestion has been to ‘stratify’ care; this would mean that patients with the greatest pain-related disability received prioritised referral to specialists in orofacial pain. Given that data from the DEEP has highlighted not only the financial cost of POFP but the day-to-day impact of living with the condition, our results would support the development of such a pathway. For more information, our article, DEEP Study: Indirect and out-of-pocket costs of Persistent Orofacial Pain, has recently been published in the Journal of Dental Research.
References
- Durham J, Shen J, Breckons M, Steele JG, Araujo-Soares V, Exley C, et al. Healthcare Cost and Impact of Persistent Orofacial Pain. Journal of dental research. 2016;95(10):1147-54.
- Macmillan Cancer Support. Cancer’s hidden price tag: revealing the costs behind the illness 2013 [Available from: https://www.macmillan.org.uk/_images/Cancers-Hidden-Price-Tag-report-England_tcm9-270862.pdf]
- Maniadakis N, Gray A. The economic burden of back pain in the UK. Pain. 2000;84(1):95-103.
Image credit: Brandon Heyer via Flikr, “064 Teeth & Eyes” (CC BY-NC-SA 2.0)