Calculating the exact costs of musculoskeletal disorders (MSDs) to the Irish economy is not straightforward, however existing figures show that MSDs are a significant economic burden to Ireland.
- MSDs the number one cause of work absence in Ireland, accounting for 50%.
- The direct cost to the economy estimated to be €750m per annum
- Ireland spends more per capita (40.9%) on sickness and healthcare benefits than 24 other countries featured in a Europe wide study.
The cost of MSDs can looked at in these categories:
Direct costs of MSDs include the cost of prevention, detection, treatment, rehabilitation and long term care. Direct costs associated with MSDs can include:
Healthcare costs
- Physician visits, physiotherapist, occupational therapist, chiropractic visits, social worker, medications, diagnostic / therapeutic procedures and tests, devices and aids, imaging, laboratory monitoring, toxicity (diagnosis, treatment), medical assist devices, emergency room, hospitalisations, outpatient surgery, complimentary and alternative medicine
Personal costs
- Transportation, patient time, carer time
Other related costs
- Home healthcare services, environmental adaptations, medical equipment, alternative therapy
Direct costs estimates require input from a number of different factors, and great variation is found across different studies. Some of the main findings include:
- For lower back pain, the most significant direct costs are related to physical therapy, inpatient services, pharmaceuticals and primary care.
- 80% of healthcare costs are generated by the 10% of those with chronic back pain and disability.
- For rheumatoid arthritis, studies indicate that direct costs increase as functional capacity decreases – making functional capacity a major cost driver.
- Direct costs compared to indirect costs, usually represent a minority of the total costs.
Indirect costs of MSDs include lost work output attributable to a reduced capacity for activity, such as lost productivity, lost earnings, lost opportunities for family members, lost earnings of family members and lost tax revenue.
There are two main types of indirect costs most commonly measured in relation to ill health in employees:
- Absence from work
- ‘Presenteeism’ or loss of productivity in an employee while they are at work with an illness or incapacity.
Presenteeism is extremely difficult to measure and there are no Irish data on presenteeism costs. As a result, most estimates of indirect costs are based on absence from work data.
It is worth noting that the recording of sickness absence is rarely accurate, as different organisations have different ways of recording absence: in some cases employees complete records themselves, in other cases managers must record the absence for them. Furthermore records are subject to biases, for example, managers tend to underreport their own absence.
The only recent Irish analysis which exists was conducted by an economic consultancy (Indecon, 2006) which was commissioned to evaluate the impact of health and safety legislation in Ireland.
- They estimated that the total annual cost of work-related accidents and ill-health was nearly €3.6 billion.
- Within this they estimated that €1.8 billion was accounted for by lost output caused by temporary and permanent absence from work.
- Another study by the Irish Business and Employers Confederation estimated that absence from work in Ireland’s smaller employers (they employ approximately 840,000 people) was costing the Irish economy €692 million each year.
Other indirect costs:
- Early retirement- Indirect costs are also associated with early retirement among people with MSDs, with studies estimating a rate of 30-50%.
- Family productivity- Indirect costs of ill health extend beyond lost productivity of the individual, often impacting on the labour participation of family members.
- Hiring help- A further extension from work-related indirect costs, are additional costs associated with hiring household help.
- Informal Care- Provision of informal care is difficult to identify, quantify and value (what is considered ‘informal care’ by some people may be considered ‘normal’ by others) it estimated that for RA the annual cost of informal care in Europe is € 2,562 per patient.
These include psychosocial burden resulting in reduced quality of life, such as job stress, economic stress, family stress and suffering.
Intangible costs are rarely included in cost calculations as it is almost impossible to properly express the intangible costs in monetary terms. However, the evaluation of intangible costs gives useful information regarding the price paid by people with MSDs in terms of quality of life
The cost calculations for MSDs in general provide relatively good estimations of the costs of non-specific MSDs given that non-specific MSDs constitute the vast majority of cases.
Calculating the costs for specific MSDs is fraught with the same difficulties as for MSDs as a whole. The majority of studies estimating the economic burden of RA have provided cost estimates.
- It estimated that the total cost of treating RA patients in Ireland was €19,596 per patient per year or €544 million.
- These costs included medical costs, drug costs, non-medical costs, the costs of informal care and other indirect costs, but do not differentiate between those of working age and those above retirement age.
- These figures are slightly higher, per patient, than those for other western European countries.
The limitations of data collection outlined above highlight some of the difficulties encountered in trying to cost the impact of MSDs for Irish employers and society.