Estimating the Cost and Carbon Output of Musculoskeletal Primary Care Management Decisions: A Retrospective Analysis of Electronic Health Records

Alex Braybrooke, Melissa Pegg, Rebecca Naylor, James Bailey, James Scott, Roanna Burgess, Dahai Yu, Simon Wathall, Kelvin P. Jordan, Robert Malcolm, Hayden Holmes, George Peat, Anirban Banerjee and Jonathan C. Hill

International Journal of Health Planning and Management, 2025, vol. 40, issue 4, 907-922

Abstract: Background Healthcare accounts for up to 5% of worldwide carbon emissions and costs global economies an estimated $9 trillion annually. Primary care accounts for up to one‐fifth of all NHS carbon emissions, with musculoskeletal (MSK) pain accounting for 14%–30% of all primary care consultations. Method A cost‐carbon calculator model was used to undertake a retrospective economic and environmental analysis of resource use for non‐inflammatory MSK pain primary care consulters. Data used to populate the model was derived from Electronic Health Records and patient surveys collected during The Multi‐level Integrated Data for Musculoskeletal Health Intelligence and ActionS GP Study. The model was utilised to estimate the mean (with 95%CI's) cost and carbon output per MSK consulter, while also examining variations at two levels: (a) the Primary Care Network (PCN), and (b) the consulter's index MSK pain site. Results One thousand eight hundred seventy‐five individuals from 30 NHS primary care practices across 13 PCNs were eligible for EHR and survey data analysis. The mean carbon and cost output per person (over 6 months) was 46.91 kg CO2e (95% CIs; 45.02, 48.81 kg CO2e) and £182.65 (95% CIs; £178.69, £190.62), respectively, with substantial variation observed across PCNs. The resource category with the highest carbon footprint was consistently pharmacological intervention across all PCNs. Individuals who consulted for multisite/widespread pain and back pain had the highest mean carbon and cost output respectively. Conclusion This is the first study, we are aware of, that presents data on both the environmental and economic impact of the primary care of non‐inflammatory MSK pain. Future work should focus on benchmarking the cost and carbon output of MSK care pathways and standardising methods that are implemented to influence sustainable practice and policy development.

Date: 2025
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