Cost of chiropractic versus medical management of adults with spine-related musculoskeletal pain: a systematic review

Ronald Farabaugh; Cheryl Hawk; Dave Taylor; Clinton Daniels; Claire Noll; Mike Schneider; John McGowan; Wayne Whalen; Ron Wilcox; Richard Sarnat; Leonard Suiter; James Whedon

doi:10.1186/s12998-024-00533-4

Table 4

Summary of findings for chiropractic management vs medical management, by year of publication

	Publication year	Study design	Summary
Bezdjian [29]	2022	CO	DC trained in Primary Spine Care—decreased:
			Hospitalization
			Opioid prescription fill
			ESI
			Specialist referral
			Diagnostic imaging
			Surgery
Harwood [5]	2022	CS	DC as 1st provider—decreased:
			Opioid and early opioid prescriptions
			Total cost, but similar to PCMD
			Out-of-pocket costs, but similar to PCMD
			MRI/CT
			1st provider—significantly less imaging and opioids
Jin [36]	2022	CO	DC or PT as 1st provider—decreased:
			Long-term healthcare costs
			Use of ESI
			Long-term opioid use
Whedon [9]	2022	CO	DC care—decreased:
			Escalation of care
			Hospitalization
			ESI and other interventional procedures
			Advanced diagnostic imaging
			Specialist visit/referral
			ED visit
Whedon [46]	2022	CO	DC care—decreased:
Whedon [46]	2022	CO	Likelihood of filling opioid prescription
Anderson [27]	2021	CO	DC 1st provider—decreased
			Diagnostic imaging
			ESI/injection procedures
			Surgery
Anderson [28]	2021	CO	DC care—decreased:
			Escalation of care:
			Imaging
			ESI/injection procedures
			ED
			Surgery
Davis [30]	2021	CO	DC care—decreased:
			PCP, specialists, and surgeon visits for spine conditions
			Spine surgery
Whedon [42]	2021	CO	DC care:
			Increased LBP care long-term costs
			Decreased total long-term costs
Whedon [43]	2021	CO	DC care—decreased:
			Adverse drug events
			Opioid dependence/abuse
			Long term care
Louis [39]	2020	CO	DC care—decreased:
Louis [39]	2020	CO	Opioid use
Whedon [45]	2020	CO	DC care—decreased:
Whedon [45]	2020	CO	Risk of filling opioid prescription
Davis [31]	2019	CO	DC care—decreased:
			Spine-related medical procedures
			Diagnostic imaging and testing
Kazis [37]	2019	CO	DC 1st provider—decreased:
Kazis [37]	2019	CO	Short and long-term opioid prescriptions
Rhon [12]	2019	CO	Manual therapy—decreased:
Rhon [12]	2019	CO	All costs, visits, and opioid prescriptions
Elder [24]	2018	PC	DC care compared to usual care:
Elder [24]	2018	PC	No statistically significant differences in costs
Whedon [44]	2018	CO	DC care—decreased:
Whedon [44]	2018	CO	Likelihood of filling opioid prescription and cost of opioids
Hong [33]	2017	CO	DC care:
			Utilization of low value diagnostic imaging slightly less than specialists but more than PCP
			Clinician ownership of imaging equipment was a predictor of low value utilization across clinician type
Fritz [32]	2015	CO	DC care:
			Decreased advanced imaging
			Decreased surgeon visits
			Increased duration of episode of care
Hurwitz [34]	2016	CO	DC care—decreased:
Hurwitz [34]	2016	CO	Costs for uncomplicated or complicated neck pain
Hurwitz [35]	2016	CO	DC care—decreased:
			Costs and episode length for uncomplicated LBP
			Costs for complicated LBP when care involved referral providers or services
Weeks [40]	2016	CO	Higher DC costs (more usage) were associated with lower opioid prescriptions
Weeks [41]	2016	CS using RCT data	DC care for chronic LBP episodes—decreased:
			Overall costs of care
			Episode duration
			Cost per episode
Leininger [52]	2016	CS using RCT data	DC care
			Decreased advanced imaging
			Decreased surgeon visits
			Decreased total healthcare costs
			Decreased lost productivity costs
			Increased duration of episode of care
Keeney [26]	2013	PCO	DC 1st provider—decreased:
Keeney [26]	2013	PCO	Back surgery
Graves [25]	2012	CO	DC care—decreased:
Graves [25]	2012	CO	Cost of episodes
Lilliedahl [38]	2010	CS	DC 1st provider—decreased:
Lilliedahl [38]	2010	CS	Overall episode costs
Grieves [47]	2009	CS	DC care:
			Increased office costs
			Approximately equal total costs for DC and MD when excluding costs of advanced imaging and referrals
Haas [48]	2005	CS	DC care:
			Increased office costs when excluding referrals
			DC and MD costs not significantly different when including referrals
Kominski [50]	2005	CS using RCT data	Excluding pharmaceutical data, adjusted mean outpatient costs greater for MD with PT, followed by DC with modalities and DC alone; MD alone lowest cost
Nelson [54]	2005	CS	DC care—decreased:
			Advanced imaging
			Surgery
			Hospitalization
			Plain film imaging
Legorreta [51]	2004	CS	DC care—decreased:
			PMPY costs
			Hospital days
			MRI and other imaging
			Surgery
Phelan [55]	2004	CS	DC care—decreased:
			Mean costs low back injury
			Compensation payments
			Mean lost workdays
			Mean total claim cost (including compensation)
			Utilization of medical ancillary services
			Hospitalization costs
Stano [61]	2002	CS	DC care:
Stano [61]	2002	CS	Increased mean office costs, when excluding costs of referral treatment, surgery, post-surgical care and advanced imaging
Cherkin [63]	1998	RCT	DC and PT care (McKenzie only) approximately equal and higher than cost of booklet
Smith [57]	1997	CS	DC care—decreased:
			Total insurance payments
			Patients with recurrent episodes tend to return to DC care
Mosley [53]	1996	CS	DC care—decreased:
			Overall costs per patient
			Imaging rate and cost per patient
			Prescriptions and prescription costs per patient
Stano [62]	1996	CS	DC care:
			Decreased total payments for first episodes
			Increased episode length
Carey [23]	1995	PCO	DC care:
Carey [23]	1995	PCO	Increased cost per episode
Shekelle [56]	1995	CS	DC care:
			Increased cost/episode
			Approximately equal costs per visit with PCMD
Stano [60]	1994	CS	DC care—decreased:
Stano [60]	1994	CS	Overall costs due to decreased hospitalization
Stano [59]	1993 episode analysis	CS	DC or PCP care—decreased:
			Hospital admissions
			DC care—decreased:
			Episode costs
Stano [58]	1993	CS	DC care—decreased:
Stano [58]	1993	CS	Healthcare costs
Jarvis [49]	1991	CS	DC care:
			Increased number of office visits/case
			Decreased work-time loss compensation
			Decreased total cost per case
			Decreased cost per office visit

CT Computer tomography; DC Chiropractor or chiropractic care; LBP Low back pain; MD Medical physician or medical care; MRI Magnetic resonance imaging; PCP/PCMD Primary care medical physician; PMPY Per member per year; PT Physical therapist or physical therapy care