DEEP Study: The Hidden Indirect Costs of Persistent Orofacial Pain

Objectives: Persistent orofacial pain (POFP) is caused by a number of conditions affecting the face and mouth. Little is understood about the economic impact of POFP, but research in other chronic pain conditions has suggested a negative impact on personal finances as well as workforce participation. The objectives of this study were to examine indirect costs of POFP including time and out-of-pocket costs to patients and their families, and costs to employer due to productivity loss.
Methods: Study-specific estimates were combined with self-reported patient data from validated questionnaires that collected information on patients’ time and out-of-pocket expenses, time absent from work and productivity losses during work. Data were collected from a cohort of patients at three time points with six-monthly intervals: M0 n=201; M6 n=173; M12 n=156. Descriptive statistics, bootstrap techniques, and a one-way ANOVA were used to analyse the pooled data.
Results: Mean costs for the patients and their families per 6 month period were £188 (95%CI: £147-228) and comprised of: (i) time and travel costs (£69; 95%CI: £56-81), (ii) out-of-pocket treatment and assessment costs (£108; 95%CI: £76-140); (iii) loss of income and care for dependents (£11; 95%CI: £10-12). Of these, treatment and assessment costs accounted for a significant proportion (p<0.05) of the total indirect costs. The mean cost to employers of absenteeism over six months (3 days; £145; 95%CI: £76-213), was significantly lower than the cost of those who reported being present at work with POFP (mean 53 days) but working at a reduced capacity (mean cost over six months £1889; 95%CI: £1044-2734, p<0.01).
Conclusions: Previous study data have highlighted the cost of POFP to the health service. These data suggest substantial additional ‘hidden’ indirect costs to both patients and employers.