A systematic review comparing the costs of chiropractic care to other interventions for spine pain in the United States

doi:10.1186/s12913-015-1140-5

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BMC Health Serv Res. 2015; 15: 474.

Published online 2015 Oct 19. doi: 10.1186/s12913-015-1140-5

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Table 1

Study design for cost comparisons in private health plans

First author	Year	Location/Plan type	Data type/Source	Data start -Data end	Eligibility	Indication/Duration	# ICD-9 codes	Inclusion	Exclusion	# Insured/# Eligible/# Included
Allen [33]	2014	National/Self-insured employer	Claims/Navistar integrated database^e	1/1/2001 - 12/31/2009	Back pain diagnosis	Low back pain/Any	77	1. Back pain episodes identified by one or more of 77 ICD-9 codes 2. 6 months of recorded continuous coverage	Cancer diagnosis, retired, died during study period	NR/21,080/14,787^d
Grieves [29]	2009	Wisconsin/HMO	Claims/Arise Health Plan	1/1/2004 - 12/31/2005	1. Continuously enrolled, and 2. Claim for visit to MD or DC for 12 ICD-9 codes	Low back pain/Any	12	1. Continuously enrolled; 2. Any claim for visit to MD or DC	Saw both MD and DC	30,000/NR/897
Liliedahl [32]	2010	Tennessee/NR	Claims/BlueCross BlueShield	10/1/2004 - 9/30/2006	1. Claim for 82 ICD-9 codes related to spine pain, and 2. CPT code for visit to MD, DO, ED, or DC	Spine pain/Any	82	CPT code for visit to MD, DO, ED, or DC	Episodes not related to MD, DO, ED, or DC, or with incomplete claims records	669,320/85,402/102,438^d
Mosley [30]	1996	Louisiana/HMO	Claims/Community Health Network of Louisiana	10/1/1994 - 10/1/1995	Claim for ICD-9 codes 720.0 to 724.9 (potentially 68 different ICD-9 codes) related to back or neck pain	Back or neck pain/Any	68	Claims related to ICD-9 codes	NR	NR/1,959/1,959
Shekelle [31]	1995	National/Fee for service	Claims/RAND Health Insurance Experiment	NR (mean 3.6 months)^b	Claim related to pain, swelling, or injury of back region	Pain, swelling, or injury of back/Any	NA	Any back-related claim as 1/2/3 symptom	1.Elderly; 2.Care paid by workers’ compensation	7,706/686/1,020^d
Smith [27]	1997	National/Fee for service	Claims/MEDSTAT	7/1/1988 - 6/30/1990	10 % sample of claims for 493 ICD-9 codes related to MSK conditions or claims for chiropractic care	Low back conditions/Any	9	10 % sample with claim related to ICD-9 codes	Unknown first-contact provider type	2,000,000^a/434,763/890
Stano [28]	1996	National/Fee for service	Claims/MEDSTAT	7/1/1988 - 6/30/1990	10 % sample of claims for 493 ICD-9 codes related to MSK conditions or claims for chiropractic care	Low back conditions/Any	9	10 % sample with claim related to ICD-9 codes	1. Unknown first-contact provider type; 2. Negative value claims	2,000,000^a/434,763/6,183
Stano [23]	1995	National/Fee for service	Claims/MEDSTAT	7/1/1988 - 6/30/1990	10 % sample of claims for 493 ICD-9 codes related to MSK conditions	Low back conditions/Any	9	10 % sample with claim related to ICD-9 codes	Negativepayments	NR/434,763/6,799
Stano [24]	1994	National/Fee for service	Claims/MEDSTAT	7/1/1988 - 6/30/1990	Claim for 493 ICD-9 codes related to MSK conditions	Low back conditions/Any	15	Claim related to ICD-9 codes	1. Coinsurance >15 %; 2. Deductibles > $200; 3. No restrictions on chiropractic or medical care	NR/395,641/42,331
Stano [22]	1993	National/Fee for service	Claims/MEDSTAT	7/1/1988 - 6/30/1990	Claim for 493 ICD-9 codes related to MSK conditions	Low back conditions/Any	15	Claim related to ICD-9 codes	1. Did not meet deductibles; 2. Did not file claims; 3. Out-of-plan use; 4. Age >65	2,000,000^a/395,641/99,675
Stano [25]	1993	National/Fee for service	Claims/MEDSTAT	7/1/1988 - 6/30/1990	Claim for 493 ICD-9 codes related to MSK conditions	Low back conditions/Any	9	10 % sample with claim related to ICD-9 codes	NR	2,000,000^a/396,000^a/7,880
Stano [26]	1993	National/Fee for service	Claims/MEDSTAT	7/1/1988 - 6/30/1990	1. Claim for 493 ICD-9 codes related to MSK conditions, or 2. Claim for chiropractic care	Low back conditions/Any	4	Claim related to ICD-9 codes	1. Did not meet deductibles; 2. Did not file claims; 3. Out-of-plan use; 4. Elderly	2,000,000^a/396,000^a/10,945

^anumber reported as estimated

^bas reported in separate study, 70 % participated for 36 months and 30 % participated for 60 months [64]

^cinsured n and eligible n reported only for studies based on claims. Insured n refers to size of insured population. Eligible n refers to size of insured population meeting stated eligibility criteria

^drefers to the number of episodes of spine pain (i.e. members could have multiple episodes)

^eas reported in separate study [65]

CPT current procedural terminology, DC doctor of chiropractic, DO doctor of osteopathy, ED emergency department, HMO health maintenance organization, ICD International Classification of Diseases, LBP low back pain, MD medical doctor, MSK musculoskeletal, NA not applicable, NR not reported, RAND Research and Development Corporation