Costing methodology and key drivers of healthcare costs within economic analyses in musculoskeletal community/primary care services: A systematic review.


Identifying variation in musculoskeletal (MSK) service costs requires the use of specific standardised metrics. There has been a large focus on costing, efficiency, and standardised metrics within the acute MSK setting, but far less attention in primary care and community settings. This data is necessary to improve efficiency and drive transformation of MSK pathways of care. Objectives: a) to assess the quality of costing methods used within MSK economic analyses based in primary and community settings, and, b) to identify which cost variables are the key drivers of MSK healthcare costs within these settings


Medline, AMED, EMBASE, CINAHL, HMIC, BNI, and HBE electronic databases were searched for eligible studies. Two reviewers independently extracted data and assessed quality of costing methods using an established checklist.


Results: 22 studies met the review inclusion criteria. The majority of studies demonstrated moderate to high quality costing methods. Costing issues included studies failing to fully justify the economic perspective, and not distinguishing between short and long run costs. Highest unit costs were; hospital admissions, outpatient visits and imaging. Highest mean utilisation was; GP visits, outpatient visits, and physiotherapy visits. However, importantly the highest mean costs per patient were; GP visits, outpatient visits, and physiotherapy visits.

Conclusion: This review identified a number of key resource use variables that are driving MSK healthcare costs in the community/primary care setting. High utilisation of these resources (rather than high unit cost) appears to be the predominant factor increasing mean healthcare costs. There is however need for greater detail with capturing these key cost drivers (such as clinical visits), to further improve the accuracy of costing information.

Cost and savings

Systematic review so no costs associated to undertake. Future work by authors will now look to next steps of making recommendations on standardising data within the area of MSK community and primary care (see:… and go to bottom of the web-page for detail on early recommendations).)


The quality and accuracy of MSK costing data collected in primary and community care needs more attention, as key drivers of MSK healthcare costs for patients accessing treatment in community and primary care settings are not the high individual unit costs which are typically collected (e.g. hospital admissions and imaging). Instead to accurately determine true patient-level costs within this setting, there needs to be greater focus on capturing details relating to the grade of treating clinicians and specific consultation length for clinical visits as these key cost drivers are not standardised across MSK services, as is often assumed. Recommendations for the collection of this information in a standardised, accurate, and consistent manor would form a useful part of a standardised MSK dataset (alongside key metrics measuring treatment outcome/performance), and would help to develop future benchmarking capabilities within these settings, supporting national data evaluations and informing healthcare policy.

Top three learning points

No other information. 

Funding acknowledgements

Roanna Burgess is supported by SWBH Your Trust Charity