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DEEP Study: Indirect and out-of-pocket costs of Persistent Orofacial Pain

Lookup NU author(s): Dr Matthew Breckons, Dr Jing Shen, Professor Luke ValeORCiD, Professor Justin DurhamORCiD



This is the authors' accepted manuscript of an article that has been published in its final definitive form by Sage Publications, Inc., 2018.

For re-use rights please refer to the publisher's terms and conditions.


Persistent Orofacial Pain (POFP) is common and caused by a group of conditions affecting the face, head or mouth. Recent research has highlighted a problematic care pathway with high costs to the healthcare provider, but the financial impact on patients and employers is not understood. This study aimed to describe patient (out-of-pocket) and employer (indirect) costs of POFP and identify whether the dichotomized Graded Chronic Pain Scale (GCPS) was predictive of costs.A cohort of 198 patients was recruited from primary and secondary care settings in the North-East of England and followed over a 24-month period. Patients completed GCPS and ‘use of health services and productivity’ questionnaires every 6 months and a ‘time and travel questionnaire’ at 14 months. Questionnaires examined the implications of healthcare utilisation on patients’ everyday lives and personal finances. Time and travel costs were calculated and applied to use of services data to estimate out-of-pocket costs, while the human capital method and ‘QQ method’ (Quantity and Quality of work completed) were used to estimate absenteeism and presenteeism costs respectively.Mean out-of-pocket costs were £333 (95%CI: 289 – 377) and indirect costs were £1242 (95%CI: 1014 – 1470) per person per six-month period (in 2017 pounds sterling). Regression analyses indicated that over six months GCPS was predictive of both out-of-pocket costs (a difference of £311 between low and high GCPS per person per six-month period, 95% CI: £280-342 ;p< 0.01, 705 observations over 24 months) and indirect costs (a difference of £2312 per person per six-month period between low and high GCPS; 95% CI: £1886-2737, p<0.01, 352 observations over 24 months).This analysis highlights ‘hidden’ costs of POFP and supports the use of the dichotomized GCPS to identify patients at risk of higher impact and associated costs and thereby stratify care pathways and occupational health support appropriately.

Publication metadata

Author(s): Breckons M, Shen J, Vale L, Durham J

Publication type: Article

Publication status: Published

Journal: Journal of Dental Research

Year: 2018

Volume: 97

Issue: 11

Pages: 1200-1206

Print publication date: 01/10/2018

Online publication date: 16/07/2018

Acceptance date: 31/03/2018

Date deposited: 06/04/2018

ISSN (print): 0022-0345

ISSN (electronic): 1544-0591

Publisher: Sage Publications, Inc.


DOI: 10.1177/0022034518773310


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