OBJECTIVES: Osteoarthritis (OA) is a common condition associated with significant disability and long-term cost. Many patients with OA experience chronic pain. We aimed to explore the healthcare resource utilization (HRU) and related costs for German patients with OA who develop chronic pain.

METHODS: A retrospective cohort study on anonymised healthcare claims data from the Institut für Angewandte Gesundheitsforschung (InGEF) database of insured persons in Germany. Patients (≥18 years) were indexed between January 2015 and December 2017 with a recent (within the last two years) diagnosis of OA. HRU and costs over a 1-year follow-up were compared between patients categorized as with (identified via diagnosis or opioid prescription) and without chronic pain. HRU categories were hospitalizations, outpatient physician contacts, incapacity to work, and prescriptions for physiotherapy, or psychotherapy. Total observed healthcare cost (combining inpatient and outpatient costs, medications, medical aids and remedies, and sick pay) per patient is expressed as mean Euros (quartile 1, quartile 3). Rate ratio (RR) was calculated using inverse-probability weighted negative binomial regression modelling (95% confidence interval).

RESULTS: Of 4,932,543 sampled individuals, 238,306 patients met the inclusion criteria (55% female; mean: 64 years). One third of these patients (34%; 80,055) were categorized as having chronic pain; 24,463 (31% of the chronic pain group) via opioid prescription. During the 1-year follow-up, HRU risk and costs were higher in all categories for patients with chronic pain vs those without, leading to a significantly higher total healthcare cost: €6801 (1439, 8153) vs €3682 (791, 3787), RR = 1.51 (1.36, 1.66).

CONCLUSIONS: The burden of disease is higher in German patients with chronic pain and OA than in those with OA alone. The prevention and treatment of chronic pain in OA could reduce the healthcare burden on patients and society.