Cost of musculoskeletal diseases: impact of work disability and functional decline.

Persons with all forms of musculoskeletal conditions incur total medical care expenditures of about US$240 billion, or about 2.9% of GDP. Of this total, approximately US$77 billion, or about 0.9% of GDP, would not have occurred in the absence of the musculoskeletal conditions. Such persons had lower labor force participation rates, resulting in indirect costs of about US$98 billion; of this amount, almost all (over US$90 billion) remained after taking into account characteristics other than the presence of a musculoskeletal condition that might result in lower earnings. Thus, the majority of direct costs incurred by persons with musculoskeletal conditions would occur in the absence of the conditions, but the wage losses would not occur were the conditions to be eradicated. The importance of indirect costs in the economics of musculoskeletal conditions is underscored by the studies of the costs of specific diseases. In all but OA, indirect costs are at least as large as, if not larger than, direct costs. Reducing the economic impact of RA, SLE, AS, and low back pain requires treatments that reduce work disability associated with each of these conditions. Some promising results from short term studies have been reported, but it would appear to be an appropriate time to inaugurate trials focused on longterm work outcomes.