Cost-Effectiveness Revisited

The Chiro.Org Blog

SOURCE:   The Chiropractic Report

David Chapman-Smith, LL.B (Hons)

As the United States faces the prospect of major reform to its healthcare system a dramatic new expert study from leading US health economists from Mercer Health and Benefits, and Harvard University analyses chiropractic management of back and neck pain and reports:

  • “Almost half of US patients with persistent back pain” seek chiropractic care.

  • “Low-back and neck pain are extremely common conditions that consume large amounts of healthcare resources”.

  • Effectiveness: chiropractic care is more effective than other modalities for treating low-back and neck pain”.

  • Cost-effectiveness: when considering effectiveness and cost together, chiropractic physician care for low-back and neck pain is highly cost-effective, and represents a good value in comparison to medical physician care and to widely accepted cost-effectiveness thresholds”.

  • “. . . chiropractic care for the treatment of low-back and neck pain is likely to achieve equal or better health outcomes at a cost that compares very favourably to most therapies that are routinely covered in US health benefits plans. As a result, the addition of chiropractic coverage for the treatment of low-back and neck pain at prices typically payable in US employer-sponsored health benefits plans will likely increase value-for-dollar.[1]

It is now over 15 years since the first study of the cost-effectiveness of chiropractic care by health economists. This was by Manga and Angus from the University of Ottawa, Canada in 1993. In a comprehensive, government-funded report titled The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back Pain [2 they concluded:

“In our view, the constellation of the evidence of:

(a) The effectiveness and cost-effectiveness of chiropractic management of low-back pain.

(b) The untested, questionable or harmful nature of many current medical therapies.

(c) The economic efficiency of chiropractic care for low-back pain compared with medical care.

(d) The safety of chiropractic levels.

(e) The higher satisfaction levels expressed by patients of chiropractors together offers an overwhelming case in favour of much greater use of chiropractic services in the management of low-back pain”.

Since then there has been much new data and research, much of which is referred to in the new Mercer Report, which deals not only with back pain but also neck pain.

The study of cost-effectiveness in healthcare and how to capture potential savings in real healthcare systems is much more complex than one might think. This month we look at the issues and the evidence. We start, however, with a review of the Mercer Report – which illustrates how this is no field for amateurs.

There’s more information on this topic at our:

Cost-Effectiveness of Chiropractic Page


  1. Choudhry N, Milstein A (2009)
    Do Chiropractic Physician Services for Treatment of Low-Back and Neck Pain Improve the Value of Health Benefit Plans? An Evidence-Based Assessment of Incremental Impact on Population Health and Total Health Care Spending
    Harvard Medical School, Boston, Mercer Health and Benefits, San Francisco.

    Review the FULL TEXT Mercer Health article

  2. Manga P, Angus D et al. (1993)
    The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back Pain,
    Pran Manga & Associates, University of Ottawa, Ottawa, Ontario.