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

PMC full text:

BMC Health Serv Res. 2015; 15: 474.

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

Copyright/License ►Request permission to reuse: Copyright © Dagenais et al. 2015
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Table 8

Adjusted vs. unadjusted cost comparisons

			Unadjusted health care costs	Comparator groups(s)			Adjusted health care costs
First author	Year	Risk adjustment variables	Chiropractic		Comparator	Lowest	Chiropractic	Comparator	Lowest	Comments
Butler [39]	2010	Physical function, back pain severity, leg pain severity	$868	1. MD care, 2 MD care + chiropractic care +/− PT care, 3. MD care + PT care, 4. Other	$264	Comparator	$6,984	$8,108	Chiropractic
Carey [40]	1995	Physical function, sciatica, income, duration of pain, worker’s compensation	$684	1. Urban medical physician primary care^a	$536	Comparator	$699	$523	Comparator
				2. Rural medical physician primary care^a
				3. Orthopedist^a
				4. HMO provider (i.e. NPs and PAs)
Haas [41]	2005	Health insurance, marital status, income	$222	Medical physician care (i.e. prescription drugs, exercise, self-care advice, PT referral)	$211	Comparator	N/A	N/A	Comparator	Adjusted costs were $14 higher for chiropractic care
Kominski [45]	2005	Demographics, physical function, pain, copayments	$558	1. Medical physician care (i.e. back care advice, exercise, bed rest, narcotic analgesics, muscle relaxants, anti-inflammatories, OTC pain relievers)	$616	Chiropractic	$570	$567	Comparator
Kominski [45]	2005	Demographics, physical function, pain, copayments	$558	2. Medical physician care + physical modalities (i.e. heat, cold, ultrasound, EMS, soft tissue and joint mobilization, mechanical traction, SET)	$616	Chiropractic	$570	$567	Comparator
Liliedahl [32]	2010	Symmetry Pharmacy Risk Groups (pharmacy claims, age, and sex)	$756	MD care	$1,037	Chiropractic	$533	$661	Chiropractic
Shekelle [31]	1995	Sociodemographics, health status, attitude, insurance status, location	$264	1. MD primary care, 2. orthopedist, 3. internist, 4. DO, 5. other providers	$166	Comparator	N/A	N/A	Comparator	Adjusting changed estimates by $13 but did not change rank order of costs
Stano [28]	1996	SysteMetrics classification	$518	MD care	$1,020	Chiropractic	N/A	N/A	Chiropractic	Risk adjusting did not change differences between groups
Stano [23]	1995	SysteMetrics classification, age, sex, location, employee/dependent, insurance type, coinsurance, deductible, type of chiropractic coverage	$493	MD care	$1,000	Chiropractic	$508	$542	Chiropractic
Stano [24]	1994	Age, sex, region, work status, employee/dependent, health plan type	$5,474	MD care	$8,427	Chiropractic	N/A	N/A	Chiropractic	Adjusted costs were $1,197 lower for chiropractic care
Stano [22]	1993	Age, sex, location, employee/dependent, work status, coinsurance, deductible, health plan coverage of chiropractic	$2,150	MD care	$3,127	Chiropractic	N/A	N/A	Chiropractic	Adjusted costs were 27 % lower for chiropractic care

^ano details reported about care received

DO doctor of osteopathy, EMS electrical muscle stimulation, HMO health maintenance organization, MD medical doctor, N/A not applicable, NP nurse practitioner, OTC over-the-counter, PA physician assistant, PT physical therapist, SET supervised exercise therapy