Cost Comparison for Spine Pain

This week from Dr. Cerami and Utah Sports and Wellness

From: BoiMed Central (BMC) Health Services Research, October 2015

Quick Summary:

This comprehensive study was designed to compare health care costs for patient with spine pain who received chiropractic care v. care from other health care providers. This review identified 25 cost comparison studies published in English since 1993 that were related to chiropractic care for spine pain in the US. Spine pain is one of the most common and costly causes of health care utilization in the United States, with 61% of patients seeking care from a medical physician (MD or DO), 28% from a chiropractor, and 11 % from both a medical physician and a physical therapist. Chiropractors in the US treat spine pain almost exclusively, with the most common indication for care being low back pain (68%), followed by neck pain (12%), and mid-back pain (6%). Only 3% of office visits to medical physicians are related to spine pain. “Patients with spine pain report higher levels of satisfaction with chiropractic care than care from a medical physician.” Chiropractors may offer a more cost-effective approach to managing spine pain as a consequence of: lower fees for office visits, use of x-rays rather than more advanced diagnostic imaging, lower referral rates to spine specialists or surgeons (implying chiropractors are achieving good clinical outcomes) and reduced need for medications, injections or surgery.

Abstract:

Although chiropractors in the United States (US) have long suggested that their approach to managing spine pain is less costly than other health care providers (HCPs), it is unclear if available evidence supports this premise. A systematic review was conducted using a comprehensive search strategy to uncover studies that compared health care costs for patients with any type of spine pain who received chiropractic care or care from other HCPs. Only studies conducted in the US and published in English between 1993 and 2015 were included. Health care costs were summarized for studies examining: 1. private health plans, 2. workers’ compensation (WC) plans, and 3. clinical outcomes. The quality of studies in the latter group was evaluated using a Consensus on Health Economic Criteria (CHEC) list. The search uncovered 1276 citations and 25 eligible studies, including 12 from private health plans, 6 from WC plans, and 7 that examined clinical outcomes. Chiropractic care was most commonly compared to care from a medical physician, with few details about the care received. Heterogeneity was noted among studies in patient selection, definition of spine pain, scope of costs compared, study duration, and methods to estimate costs. Overall, cost comparison studies from private health plans and WC plans reported that health care costs were lower with chiropractic care. In studies that also examined clinical outcomes, there were few differences in efficacy between groups, and health care costs were higher for those receiving chiropractic care. The effects of adjusting for differences in sociodemographic, clinical, or other factors between study groups were unclear. Although cost comparison studies suggest that health care costs were generally lower among patients whose spine pain was managed with chiropractic care, the studies reviewed had many methodological limitations. Better research is needed to determine if these differences in health care costs were attributable to the type of HCP managing their care.

These authors also note:

• “Spine pain is one of the most common and costly causes of health care utilization in the United States, with 61% of patients seeking care from a medical physician (MD or DO), 28% from  a chiropractor, and 11 % from both a medical physician and a physical therapist.”
  • “In eleven (92%) studies, health care costs were lower for patients whose spine pain was managed with chiropractic care.”
  • “Overall, 11/12 (92%) studies in private health plans reported that health care costs were lower for members whose spine pain was managed by chiropractic care, by a mean of 36%.”
• The authors note that the only study reporting higher health care costs with chiropractic care may be explained as chiropractors billing more but being paid a smaller amount.
• These authors note that it is important to understand that “indirect costs (e.g. lost productivity) account for a majority of the total costs of spine pain, and that they were “generally lower for patients receiving chiropractic care.” [Important, implying that chiropractic care keeps back pain patients working or gets them to return to work more quickly.]
• “In general, the findings in this review suggest that health care costs may be lower when spine pain is managed with chiropractic care in the US, even if such differences are sometimes attributable to sociodemographic, clinical, or other factors rather than healthcare providers.”
• “These findings echo that of a review published in 1993 that examined studies in which LBP was managed by spinal manipulation, chiropractic care, other interventions (e.g. physical modalities, medications, exercise) throughout the world (e.g. Australia, Canada, Egypt, Italy, the Netherlands, New Zealand, Nigeria, Sweden, United Kingdom, and US). Based on the favorable short-term clinical improvements and lower costs of care reported in those studies, the previous review concluded that health care costs could be reduced if a higher proportion of patients with spine pain received chiropractic care rather than other interventions, and recommended a greater integration of chiropractors into the publicly financed health care system in Ontario, Canada.”
  • “However, that recommendation was never implemented, and publicly financed coverage of chiropractic services was subsequently eliminated in Ontario to alleviate budget deficits.”
  • “Other studies have reported similarly favorable clinical or economic results [from chiropractic care] in both Canada (i.e. Calgary, Ottawa) and the US (i.e. Boston).”
• “Overall, cost comparison studies from private health plans and WC plans reported that health care costs were lower with chiropractic care.”
• The “cost comparison studies suggest that health care costs were generally lower among patients whose spine pain was managed with chiropractic care.