Healthcare Costs, Time to Fitness for Work, and Related Factors in Chronic Complex Regional Pain Syndrome: A Comparative and Longitudinal Study of 5-Year Follow-Up

Abstract

Purpose

To assess and compare the healthcare costs, time to fitness for work (TFW) between chronic complex regional pain syndrome (CRPS) and non-CRPS; and identify factors associated with these outcomes in a comparative longitudinal study.

Patients and Methods

148 patients with chronic CRPS of the hand and 273 patients with chronic hand impairments but without CRPS (non-CRPS) were admitted at a Swiss rehabilitation clinic between 2007 and 2016. Healthcare costs and TFW were retrieved from insurance data over 5 years after the accident. Socio-demographic factors, biopsychosocial complexity measured by means of the INTERMED questionnaire, pain intensity and DASH disability scores were collected during rehabilitation. Generalized estimation equations and Cox proportional-hazards models were used to identify factors associated with outcomes.

Results

Healthcare costs were increased by 20% for the CRPS versus non-CRPS group (coefficient = 1.20, 95% CI = 1.08–1.35, p<0.001). The median TFW was longer for CRPS than non-CRPS patients (816 vs 672 days, p = 0.02). After adjusting for covariates, TFW did not differ between the two groups (hazard ratio = 0.94, 95% CI = 0.73–1.21, p=0.61). For CRPS patients, higher healthcare costs were associated with severe or moderate initial injury, high INTERMED or DASH disability scores. Longer TFW were associated with severe initial injury, low educational level, no work contract, and high INTERMED or DASH disability scores.

Conclusion

Overall, the healthcare costs were higher for CRPS than non-CRPS patients, but the TFW was comparable. We demonstrated also the significant associations of disability and biopsychosocial factors with the healthcare costs and TFW in CRPS patients.

Keywords:

• complex regional pain syndrome
• healthcare costs
• biopsychosocial complexity
• work incapacity
• fitness for work
• CRPS

Abbreviations

AR, Autoregressive; BPS, Biopsychosocial; CI, Confidence Intervals; CRPS, Complex regional pain syndrome; DASH, Disabilities of the Arm, Shoulder, and Hand; GEE, Generalized estimation equations; HR, Hazard Ratio; ICD, International Classification of Diseases; QIC, Quasi-information criterion; TFW, Time to fitness for work; VAS, Visual Analog Scale.

Data Sharing Statement

All datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.

Ethics Approval and Informed Consent

This retrospective comparative study was approved by the ethics committee of the local medical association (Commission cantonale d'ethique de la recherche sur l'être humain (CER-VD 2021-01222)).

Author Contributions

HPD, BL, and FL contributed to the conceptualization of the research project. HPD had full access to all the data in the study, performed the statistical analysis, and synthesized the results. SMS analyzed the integrity of the insurance data. HPD, BL, SMS, MK, PV, CB, and FL analyzed and interpreted the results. HPD and FL wrote the first draft of the manuscript. All authors made a significant contribution to the work reported, and took part in drafting, revising, or critically reviewing the article. All authors gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest.