The Most Expensive Medical Condition Is Not What You Think

In a minute, I’m going to ask you what the most expensive medical condition is in the American healthcare system. Before you guess, however, I’m going to explain what I mean by “most expensive.”

I’m not talking about cost per patient. Some people with cancer receive hundreds of thousands of dollars of chemotherapy per year, as do some children with rare genetic disorders. Instead, I’m referring to overall spending on a disease. That means it affects a lot of people for a long time, while being serious enough to generate plenty of medical bills.

So, don’t guess the common cold. It is common but it is also short-lived and inexpensive to treat.

And don’t guess something like multiple sclerosis. It’s serious and expensive, but not common enough to make it into the top ten.

Now it’s time for you to guess. Don’t read any further until you’ve committed yourself to an answer.

I said don’t read further!

Did you guess heart disease? That is what I guessed before I researched the topic. It is a common disorder (a set of disorders, actually). It involves expensive treatments, like cardiac catherization and bypass surgeries. And it’s chronic, too, even after those expensive treatments, because it still requires life long medications. But I was wrong to guess heart disease. It clocks in at number four, with “only” $90 billion in spending (from a 2016 study, where these numbers come from).

If you guessed diabetes, you were also wrong, but you did better than me. That disease came in at number three, with $111 billion of spending. (Take that myocardial infarction!)

Now for the most expensive medical condition in the United States (drum roll……). It is low back and neck pain. Our frickin’ spines plague us enough to cost over $130 billion per year.

Even though I am a lifelong sufferer of low back pain, I was surprised that this chronic condition took the crown. It is true that back and neck pain sometimes lead to expensive treatments. I know this well, having received spinal surgery back in 1991. But most years, most people with back pain don’t receive expensive surgeries. They take pain medications, perhaps attend physical therapy appointments, but they don’t receive expensive chemotherapy or outrageously priced insulin.

On the other hand, many people with back and neck pain receive X-rays and MRI tests, even when those tests are not helpful. They receive pain medicines, physical therapy appointments, trips to chiropractors; many miss work when experiencing a pain exacerbation. In addition, many receive surgery, and about half of those procedures are unnecessary. Half!

Back and neck pain often afflict people in what should be the happiest and most productive years of their life. Our country needs to take back and neck pain more seriously, not just because these problems are expensive, but because they cause so much suffering.

In 2021 the budget for the national cancer institute (NCI) was over $7 billion. The NCI is that portion of the NIH dedicated to conducting research on cancer.

By contrast, the 2021 budget for NIAMS (the national institute for arthritis, musculoskeletal and skin diseases—yes, they even threw skin diseases into the mix!) was $685 million. That’s only a tenth of the budget of the NCI.

That funding disparity is flat out wrong. We need to invest in basic science and clinical research to address these painful, debilitating conditions. Instead, we are likely facing huge, across-the-board reductions in NIH funding, of up to 40%, because so many politicians have lost the will to fight for science funding.

Americans spend more on low back and neck pain than on any other medical condition. Time for a commensurate investment in research to find ways to reduce the amount of suffering caused by chronic pain.