A Systematic Review Comparing the Costs of Chiropractic Care to other Interventions for
Spine Pain in the United States

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SOURCE:   BMC Health Serv Res. 2015 (Oct 19) ~ FULL TEXT

Simon Dagenais, O’Dane Brady, Scott Haldeman
and Pran Manga

Spine Research LLC,
540 Main Street #7,
Winchester, MA, 01890, USA.

BACKGROUND:   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.

METHODS:   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.

RESULTS:   The search uncovered 1,276 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.

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CONCLUSIONS:   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.

Keywords   Chiropractic Spine pain Cost comparison Economic evaluation United States

From the FULL TEXT Article:


Spine pain is one of the most common and costly causes of health care utilization in the United States (US), with 61% of patients seeking care from a medical physician (i.e. medical doctor (MD) or doctor of osteopathy (DO)), 28% from a chiropractor, and 11% from both a medical physician and a physical therapist (PT) [1–4]. Chiropractors in the US treat spine pain almost exclusively, with the most common indication for care being low back pain (LBP) (68%), followed by neck pain (12%), and mid-back pain (6%) [5]. By contrast, only 3% of office visits to medical physicians are related to spine pain [6].

Studies have reported that chiropractors have more confidence in their ability to manage spine pain than medical physicians, and that patients with spine pain report higher levels of satisfaction with chiropractic care than care from a medical physician [7–9]. Proponents of chiropractic maintain that it offers a more cost-effective approach to managing spine pain for a variety of reasons, including lower fees for office visits, use of x-rays rather than more advanced diagnostic imaging, lower referral rates to spine specialists or surgeons, and scope of practice limitations related to medications, injections, and surgery [10].

SOURCE:   Read the rest of this Full Text article now!