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Research ArticleArticle

Healthcare Utilization and Costs for Musculoskeletal Disorders in Ontario, Canada

J. Denise Power, Anthony V. Perruccio, J. Michael Paterson, Mayilee Canizares, Christian Veillette, Peter C. Coyte, Elizabeth M. Badley, Nizar N. Mahomed and Y. Raja Rampersaud
The Journal of Rheumatology April 2022, jrheum.210938; DOI: https://doi.org/10.3899/jrheum.210938
J. Denise Power
This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). The analyses, conclusions, opinions, and statements expressed herein are those of the authors and not those of the funding or data sources; no endorsement is intended or should be inferred. J.D. Power, PhD, M. Canizares, PhD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto; A.V. Perruccio, PhD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto; J.M. Paterson, MSc, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, and ICES, Toronto; C. Veillette, MD, MSc, N.N. Mahomed, MD, ScD, Y.R. Rampersaud, MD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, and Orthopaedics, Department of Surgery, University of Toronto, Toronto; P.C. Coyte, PhD, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto; E.M. Badley, PhD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. J.D. Power, 399 Bathurst Street MP10-326, Toronto, ON M5T 2S8, Canada. Email: dpower@uhnres.utoronto.ca. Accepted for publication March 20, 2022.
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Anthony V. Perruccio
This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). The analyses, conclusions, opinions, and statements expressed herein are those of the authors and not those of the funding or data sources; no endorsement is intended or should be inferred. J.D. Power, PhD, M. Canizares, PhD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto; A.V. Perruccio, PhD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto; J.M. Paterson, MSc, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, and ICES, Toronto; C. Veillette, MD, MSc, N.N. Mahomed, MD, ScD, Y.R. Rampersaud, MD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, and Orthopaedics, Department of Surgery, University of Toronto, Toronto; P.C. Coyte, PhD, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto; E.M. Badley, PhD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. J.D. Power, 399 Bathurst Street MP10-326, Toronto, ON M5T 2S8, Canada. Email: dpower@uhnres.utoronto.ca. Accepted for publication March 20, 2022.
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  • ORCID record for Anthony V. Perruccio
J. Michael Paterson
This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). The analyses, conclusions, opinions, and statements expressed herein are those of the authors and not those of the funding or data sources; no endorsement is intended or should be inferred. J.D. Power, PhD, M. Canizares, PhD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto; A.V. Perruccio, PhD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto; J.M. Paterson, MSc, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, and ICES, Toronto; C. Veillette, MD, MSc, N.N. Mahomed, MD, ScD, Y.R. Rampersaud, MD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, and Orthopaedics, Department of Surgery, University of Toronto, Toronto; P.C. Coyte, PhD, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto; E.M. Badley, PhD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. J.D. Power, 399 Bathurst Street MP10-326, Toronto, ON M5T 2S8, Canada. Email: dpower@uhnres.utoronto.ca. Accepted for publication March 20, 2022.
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Mayilee Canizares
This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). The analyses, conclusions, opinions, and statements expressed herein are those of the authors and not those of the funding or data sources; no endorsement is intended or should be inferred. J.D. Power, PhD, M. Canizares, PhD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto; A.V. Perruccio, PhD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto; J.M. Paterson, MSc, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, and ICES, Toronto; C. Veillette, MD, MSc, N.N. Mahomed, MD, ScD, Y.R. Rampersaud, MD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, and Orthopaedics, Department of Surgery, University of Toronto, Toronto; P.C. Coyte, PhD, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto; E.M. Badley, PhD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. J.D. Power, 399 Bathurst Street MP10-326, Toronto, ON M5T 2S8, Canada. Email: dpower@uhnres.utoronto.ca. Accepted for publication March 20, 2022.
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Christian Veillette
This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). The analyses, conclusions, opinions, and statements expressed herein are those of the authors and not those of the funding or data sources; no endorsement is intended or should be inferred. J.D. Power, PhD, M. Canizares, PhD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto; A.V. Perruccio, PhD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto; J.M. Paterson, MSc, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, and ICES, Toronto; C. Veillette, MD, MSc, N.N. Mahomed, MD, ScD, Y.R. Rampersaud, MD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, and Orthopaedics, Department of Surgery, University of Toronto, Toronto; P.C. Coyte, PhD, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto; E.M. Badley, PhD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. J.D. Power, 399 Bathurst Street MP10-326, Toronto, ON M5T 2S8, Canada. Email: dpower@uhnres.utoronto.ca. Accepted for publication March 20, 2022.
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  • ORCID record for Christian Veillette
Peter C. Coyte
This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). The analyses, conclusions, opinions, and statements expressed herein are those of the authors and not those of the funding or data sources; no endorsement is intended or should be inferred. J.D. Power, PhD, M. Canizares, PhD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto; A.V. Perruccio, PhD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto; J.M. Paterson, MSc, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, and ICES, Toronto; C. Veillette, MD, MSc, N.N. Mahomed, MD, ScD, Y.R. Rampersaud, MD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, and Orthopaedics, Department of Surgery, University of Toronto, Toronto; P.C. Coyte, PhD, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto; E.M. Badley, PhD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. J.D. Power, 399 Bathurst Street MP10-326, Toronto, ON M5T 2S8, Canada. Email: dpower@uhnres.utoronto.ca. Accepted for publication March 20, 2022.
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  • ORCID record for Peter C. Coyte
Elizabeth M. Badley
This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). The analyses, conclusions, opinions, and statements expressed herein are those of the authors and not those of the funding or data sources; no endorsement is intended or should be inferred. J.D. Power, PhD, M. Canizares, PhD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto; A.V. Perruccio, PhD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto; J.M. Paterson, MSc, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, and ICES, Toronto; C. Veillette, MD, MSc, N.N. Mahomed, MD, ScD, Y.R. Rampersaud, MD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, and Orthopaedics, Department of Surgery, University of Toronto, Toronto; P.C. Coyte, PhD, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto; E.M. Badley, PhD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. J.D. Power, 399 Bathurst Street MP10-326, Toronto, ON M5T 2S8, Canada. Email: dpower@uhnres.utoronto.ca. Accepted for publication March 20, 2022.
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Nizar N. Mahomed
This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). The analyses, conclusions, opinions, and statements expressed herein are those of the authors and not those of the funding or data sources; no endorsement is intended or should be inferred. J.D. Power, PhD, M. Canizares, PhD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto; A.V. Perruccio, PhD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto; J.M. Paterson, MSc, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, and ICES, Toronto; C. Veillette, MD, MSc, N.N. Mahomed, MD, ScD, Y.R. Rampersaud, MD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, and Orthopaedics, Department of Surgery, University of Toronto, Toronto; P.C. Coyte, PhD, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto; E.M. Badley, PhD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. J.D. Power, 399 Bathurst Street MP10-326, Toronto, ON M5T 2S8, Canada. Email: dpower@uhnres.utoronto.ca. Accepted for publication March 20, 2022.
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Y. Raja Rampersaud
This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). The analyses, conclusions, opinions, and statements expressed herein are those of the authors and not those of the funding or data sources; no endorsement is intended or should be inferred. J.D. Power, PhD, M. Canizares, PhD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto; A.V. Perruccio, PhD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto; J.M. Paterson, MSc, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, and ICES, Toronto; C. Veillette, MD, MSc, N.N. Mahomed, MD, ScD, Y.R. Rampersaud, MD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, and Orthopaedics, Department of Surgery, University of Toronto, Toronto; P.C. Coyte, PhD, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto; E.M. Badley, PhD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. J.D. Power, 399 Bathurst Street MP10-326, Toronto, ON M5T 2S8, Canada. Email: dpower@uhnres.utoronto.ca. Accepted for publication March 20, 2022.
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Abstract

Objective To examine the magnitude and costs of ambulatory primary care, specialist physician care, and hospital service use for musculoskeletal disorders (MSDs) in Canada's largest province, Ontario.

Methods Administrative health databases were analyzed for fiscal year 2013–2014 for adults aged ≥ 18 years, including data on physician services, emergency department (ED) visits, and hospitalizations. International Classification of Diseases diagnostic codes were used to identify MSD services. A validated algorithm was used to estimate direct medical costs. Person-visit rates and numbers of persons and visits were tabulated by care setting, age, sex, and physician specialty. Data were examined for all MSDs combined, as well as for specific diagnostic groupings.

Results Overall, 3.1 million adult Ontarians (28.5%) made over 8 million outpatient physician visits associated with MSDs. These included 5.6 million primary care visits. MSDs accounted for 560,000 (12.3%) of all adult ED visits. Total costs for MSD-related care were $1.6 billion, with 12.6% of costs attributed to primary care, 9.2% to specialist care, 8.6% to ED care, 8.5% to day surgery, and 61.2% associated with inpatient hospitalizations. Costs due to arthritis accounted for 40% of total MSD care costs ($639 million). MSD-related imaging costs were $169 million, yielding a total cost estimate of $1.8 billion for MSDs overall.

Conclusion MSDs place a significant and costly burden on the healthcare system. Health system planning needs to consider the large and escalating demand for care to reduce both the individual and population burden.

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The Journal of Rheumatology
Vol. 49, Issue 5
1 May 2022
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Healthcare Utilization and Costs for Musculoskeletal Disorders in Ontario, Canada
J. Denise Power, Anthony V. Perruccio, J. Michael Paterson, Mayilee Canizares, Christian Veillette, Peter C. Coyte, Elizabeth M. Badley, Nizar N. Mahomed, Y. Raja Rampersaud
The Journal of Rheumatology Apr 2022, jrheum.210938; DOI: 10.3899/jrheum.210938

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Healthcare Utilization and Costs for Musculoskeletal Disorders in Ontario, Canada
J. Denise Power, Anthony V. Perruccio, J. Michael Paterson, Mayilee Canizares, Christian Veillette, Peter C. Coyte, Elizabeth M. Badley, Nizar N. Mahomed, Y. Raja Rampersaud
The Journal of Rheumatology Apr 2022, jrheum.210938; DOI: 10.3899/jrheum.210938
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