{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T15:33:57Z","timestamp":1792510437595,"version":"4.5.0"},"reference-count":27,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2023,7,12]],"date-time":"2023-07-12T00:00:00Z","timestamp":1689120000000},"content-version":"unspecified","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009032","name":"Pfizer UK","doi-asserted-by":"publisher","award":["NA"],"award-info":[{"award-number":["NA"]}],"id":[{"id":"10.13039\/100009032","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,6,28]]},"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Despite the prevalence of osteoarthritis (OA) in England, few studies have examined the health economic impact of chronic pain associated with OA. The aim of this study was to compare outcomes in patients with moderate-to-severe chronic pain associated with OA and matched controls without known OA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective, longitudinal, observational cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Electronic records extracted from the Clinical Practice Research Datalink GOLD primary care database linked to Hospital Episode Statistics (HES) data set.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Patients (cases; n=5931) \u226518 years and with existing diagnosis of OA and moderate-to-severe pain associated with their OA, and controls matched on age, sex, comorbidity burden, general practitioner (GP) practice and availability of HES data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>None.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>Total healthcare resource use (HCRU) and direct healthcare costs during 0\u20136, 0\u201312, 0\u201324 and 0\u201336 months of follow-up. Secondary outcomes measures included pharmacological management and time to total joint replacement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Patients with moderate-to-severe chronic pain associated with OA used significantly more healthcare services versus matched controls, reflected by higher HCRU and significantly higher direct costs. During the first 12 months\u2019 follow-up, cases had significantly more GP consultations, outpatient attendances, emergency department visits and inpatient stays than matched controls (all p&lt;0.0001). Total mean costs incurred by cases during 0\u201312 months\u2019 follow-up were five times higher in cases versus controls (mean (SD): \u00a34199 (\u00a33966) vs \u00a3781 (\u00a32073), respectively). Extensive cycling through pharmacological therapies was observed; among cases, 2040 (34.4%), 1340 (22.6%), 841 (14.2%), 459 (7.7%) and 706 (11.9%) received 1\u20135, 6\u201310, 11\u201315, 16\u201320 and &gt;20 lines of therapy, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This wide-ranging, longitudinal, observational study of real-world primary and secondary care data demonstrates the impact of moderate-to-severe chronic pain associated with OA in patients compared with matched controls. Further studies are required to fully quantify the health economic burden of moderate-to-severe pain associated with OA.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-067545","type":"journal-article","created":{"date-parts":[[2023,7,12]],"date-time":"2023-07-12T10:38:27Z","timestamp":1689158307000},"page":"e067545","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Health economic impact of moderate-to-severe chronic pain associated with osteoarthritis in England: a retrospective analysis of linked primary and secondary care data"],"prefix":"10.1136","volume":"13","author":[{"given":"Greg","family":"Coates","sequence":"first","affiliation":[{"name":"Pfizer Ltd, Tadworth, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Clewes","sequence":"additional","affiliation":[{"name":"Pfizer Ltd, Tadworth, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Lohan","sequence":"additional","affiliation":[{"name":"Pfizer Australia Pty Ltd, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Stevenson","sequence":"additional","affiliation":[{"name":"Pfizer Ltd, Tadworth, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6977-435X","authenticated-orcid":false,"given":"Robert","family":"Wood","sequence":"additional","affiliation":[{"name":"Adelphi Real World, Bollington, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theo","family":"Tritton","sequence":"additional","affiliation":[{"name":"Adelphi Real World, Bollington, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger","family":"Knaggs","sequence":"additional","affiliation":[{"name":"Pain Centre Versus Arthritis and NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alastair J","family":"Dickson","sequence":"additional","affiliation":[{"name":"Primary Care Rheumatology & Musculoskeletal Medicine Society, York, UK"},{"name":"The North of England Low Back Pain Pathway, NIHR Applied Research Collaboration North East and North Cumbria, St Nicholas\u2019 Hospital, Newcastle Upon Tyne, UK"},{"name":"AD Outcomes Ltd, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Walsh","sequence":"additional","affiliation":[{"name":"Pain Centre Versus Arthritis and NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,7,12]]},"reference":[{"key":"2025121510054435000_13.7.e067545.1","doi-asserted-by":"publisher","DOI":"10.1093\/bmb\/lds038"},{"key":"2025121510054435000_13.7.e067545.2","unstructured":"NICE . 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