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Open Access Research article

Psychiatric comorbidity as predictor of costs in back pain patients undergoing disc surgery: a longitudinal observational study

Alexander Konnopka1*, Margrit Löbner2, Melanie Luppa2, Dirk Heider12, Sven Heinrich1, Steffi Riedel-Heller2, Hans Jörg Meisel3, Lutz Günther4, Jürgen Meixensberger5 and Hans-Helmut König1

Author Affiliations

1 Department of Medical Sociology and Health Economics, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany

2 Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany

3 Department of Neurosurgery, Berufsgenossenschaftliche Kliniken Bergmannstrost, Halle (Saale), Germany

4 Department of Neurosurgery, Hospital St. Georg gGmbH, Leipzig, Germany

5 Department of Neurosurgery, University of Leipzig, Leipzig, Germany

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BMC Musculoskeletal Disorders 2012, 13:165  doi:10.1186/1471-2474-13-165

Published: 3 September 2012



Psychiatric comorbidity is common in back pain patients undergoing disc surgery and increases economic costs in many areas of health. The objective of this study was to analyse psychiatric comorbidity as predictor of direct and indirect costs in back pain patients undergoing disc surgery in a longitudinal study design.


A sample of 531 back pain patients was interviewed after an initial disc surgery (T0), 3 months (T1) and 15 months (T2) using the Composite International Diagnostic Interview to assess psychiatric comorbidity and a modified version of the Client Sociodemographic and Service Receipt Inventory to assess resource utilization and lost productivity for a 3-month period prior interview. Health care utilization was monetarily valued by unit costs and productivity by labour costs. Costs were analysed using random coefficient models and bootstrap techniques.


Psychiatric comorbidity was associated with significantly (p < 0.05) increased direct (+664 Euro) and indirect costs (+808 Euro) at T0. The direct cost difference predominantly resulted from medical health care utilization and was nearly unchanged at T2. Further important cost predictors were clinical variables like the presence of chronic medical disease, the number of previous disc surgeries, and time and gender.


Psychiatric comorbidity presents an important predictor of direct and indirect costs in back pain patients undergoing disc surgery, even if patients do not utilize mental health care. This effect seems to be stable over time. More attention should be given to psychiatric comorbidity and cost-effective treatments should be applied to treat psychiatric comorbidity in back pain patients undergoing disc surgery to reduce health care utilization and costs associated with psychiatric comorbidity.

Back pain; Disc surgery; Psychiatric comorbidity; Cost; Economic