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Cost Analysis Related to Dose-response of Spinal Manipulative Therapy for Chronic Low Back Pain

By |November 12, 2016|Chiropractic Care, Chronic Low Back Pain, Cost-Effectiveness|

Cost Analysis Related to Dose-response of Spinal Manipulative Therapy for Chronic Low Back Pain: Outcomes from a Randomized Controlled Trial

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther. 2014 (Jun); 37 (5): 300–311

Darcy A. Vavrek, ND, MS, Rajiv Sharma, PhD,
Mitchell Haas, DC, MA

University of Western States,
Portland, OR.


OBJECTIVE:   The purpose of this analysis is to report the incremental costs and benefits of different doses of spinal manipulative therapy (SMT) in patients with chronic low back pain (LBP).

METHODS:   We randomized 400 patients with chronic LBP to receive a dose of 0, 6, 12, or 18 sessions of SMT. Participants were scheduled for 18 visits for 6 weeks and received SMT or light massage control from a doctor of chiropractic. Societal costs in the year after study enrollment were estimated using patient reports of health care use and lost productivity. The main health outcomes were the number of pain-free days and disability-free days. Multiple regression was performed on outcomes and log-transformed cost data.

There are more articles like this @ our:

Low Back Pain and Chiropractic Page

and the:

Cost-Effectiveness of Chiropractic Page

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Cost-effectiveness of Spinal Manipulative Therapy, Supervised Exercise, and Home Exercise for Older Adults with Chronic Neck Pain

By |November 10, 2016|Cost-Effectiveness|

Cost-effectiveness of Spinal Manipulative Therapy, Supervised Exercise, and Home Exercise for Older Adults with Chronic Neck Pain

The Chiro.Org Blog


SOURCE:   Spine J. 2016 (Nov); 16 (11): 1292–1304

Brent Leininger, DC, MS, Christine McDonough, PT, PhD,
Roni Evans, DC, MS, PhD, Tor Tosteson, ScD,
Anna N.A. Tosteson, ScD, Gert Bronfort, DC, PhD

Integrative Health & Wellbeing Research Program,
Center for Spirituality & Healing,
University of Minnesota,
B296 Mayo Memorial Building,
420 Delaware St SE, Minneapolis, MN 55455, USA


BACKGROUND CONTEXT:   Chronic neck pain is a prevalent and disabling condition among older adults. Despite the large burden of neck pain, little is known regarding the cost-effectiveness of commonly used treatments.

PURPOSE:   This study aimed to estimate the cost-effectiveness of home exercise and advice (HEA), spinal manipulative therapy (SMT) plus HEA, and supervised rehabilitative exercise (SRE) plus HEA.

STUDY DESIGN/SETTING:   Cost-effectiveness analysis conducted alongside a randomized clinical trial (RCT) was performed.

PATIENT SAMPLE:   A total of 241 older adults (≥65 years) with chronic mechanical neck pain comprised the patient sample.

OUTCOME MEASURES:   The outcome measures were direct and indirect costs, neck pain, neck disability, SF–6D-derived quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) over a 1–year time horizon.

METHODS:   This work was supported by grants from the National Center for Complementary and Integrative Health (#F32AT007507), National Institute of Arthritis and Musculoskeletal and Skin Diseases (#P60AR062799), and Health Resources and Services Administration (#R18HP01425). The RCT is registered at ClinicalTrials.gov (#NCT00269308).

A societal perspective was adopted for the primary analysis. A healthcare perspective was adopted as a sensitivity analysis. Cost-effectiveness was a secondary aim of the RCT which was not powered for differences in costs or QALYs. Differences in costs and clinical outcomes were estimated using generalized estimating equations and linear mixed models, respectively. Cost-effectiveness acceptability curves were calculated to assess the uncertainty surrounding cost-effectiveness estimates.

There are more articles like this @ our:

Cost-Effectiveness of Chiropractic Page

and the:

Chronic Neck Pain and Chiropractic Page

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Cost-Effectiveness Of General Practice Care For Low Back Pain: A Systematic Review

By |October 25, 2016|Cost-Effectiveness|

Cost-Effectiveness Of General Practice Care For Low Back Pain: A Systematic Review

The Chiro.Org Blog


SOURCE:   Eur Spine J. 2011 (Jul); 20 (7): 1012–1023

Chung-Wei Christine Lin, Marion Haas, Chris G. Maher,
Luciana A. C. Machado, Maurits W. van Tulder

The George Institute for Global Health and
Sydney Medical School,
The University of Sydney,
PO Box M201, Missenden Rd,
Sydney, NSW 2050, Australia.


Care from a general practitioner (GP) is one of the most frequently utilised healthcare services for people with low back pain and only a small proportion of those with low back pain who seek care from a GP are referred to other services. The aim of this systematic review was to evaluate the evidence on cost-effectiveness of GP care in non-specific low back pain. We searched clinical and economic electronic databases, and the reference list of relevant systematic reviews and included studies to June 2010. Economic evaluations conducted alongside randomised controlled trials with at least one GP care arm were eligible for inclusion. Two reviewers independently screened search results and extracted data.

Eleven studies were included; the majority of which conducted a cost-effectiveness or cost-utility analysis. Most studies investigated the cost-effectiveness of usual GP care. Adding advice, education and exercise, or exercise and behavioural counselling, to usual GP care was more cost-effective than usual GP care alone. Clinical rehabilitation and/or occupational intervention, and acupuncture were more cost-effective than usual GP care. One study investigated the cost-effectiveness of guideline-based GP care, and found that adding exercise and/or spinal manipulation was more cost-effective than guideline-based GP care alone.

There are more articles like this @ our:

Cost-Effectiveness of Chiropractic Page

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Cost-Effectiveness of Non-Invasive and
Non-Pharmacological Interventions for Low Back Pain

By |August 24, 2016|Cost-Effectiveness, Low Back Pain|

Cost-Effectiveness of Non-Invasive and Non-Pharmacological Interventions for Low Back Pain:
A Systematic Literature Review

The Chiro.Org Blog


SOURCE:   Applied Health Econ & Health Policy 2016 (Aug 22)

Lazaros Andronis, Philip Kinghorn, Suyin Qiao,
David G. T. Whitehurst, Susie Durrell, Hugh McLeod

Health Economics Unit,
Public Health Building,
University of Birmingham,
Birmingham, B15 2TT, UK.
l.andronis@bham.ac.uk


BACKGROUND:   Low back pain (LBP) is a major health problem, having a substantial effect on peoples’ quality of life and placing a significant economic burden on healthcare systems and, more broadly, societies. Many interventions to alleviate LBP are available but their cost effectiveness is unclear.

OBJECTIVES:   To identify, document and appraise studies reporting on the cost effectiveness of non-invasive and non-pharmacological treatment options for LBP.

METHODS:   Relevant studies were identified through systematic searches in bibliographic databases (EMBASE, MEDLINE, PsycINFO, Cochrane Library, CINAHL and the National Health Service Economic Evaluation Database), ‘similar article’ searches and reference list scanning. Study selection was carried out by three assessors, independently. Study quality was assessed using the Consensus on Health Economic Criteria checklist. Data were extracted using customized extraction forms.

RESULTS:   Thirty-three studies were identified. Study interventions were categorised as:

(1) combined physical exercise and psychological therapy,

(2) physical exercise therapy only,

(3) information and education, and

(4) manual therapy.

Interventions assessed within each category varied in terms of their components and delivery. In general, combined physical and psychological treatments, information and education interventions, and manual therapies appeared to be cost effective when compared with the study-specific comparators. There is inconsistent evidence around the cost effectiveness of physical exercise programmes as a whole, with yoga, but not group exercise, being cost effective.

There are more articles like this @ our:

Low Back Pain and Chiropractic Page

and the:

Cost-Effectiveness of Chiropractic Page

(more…)

Variations in Patterns of Utilization and Charges for the Care of Low Back Pain in North Carolina, 2000 to 2009: A Statewide Claims’ Data Analysis

By |May 18, 2016|Cost-Effectiveness, Low Back Pain|

Variations in Patterns of Utilization and Charges for the Care of Low Back Pain in North Carolina, 2000 to 2009: A Statewide Claims’ Data Analysis

The Chiro.Org Blog


SOURCE:   J Manip Physiol Ther. 2016 (May); 39 (4): 252–262

Eric L. Hurwitz, DC, PhD, Dongmei Li, PhD,
Jenni Guillen, MS, Michael J. Schneider, DC, PhD,
Joel M. Stevans, DC, Reed B. Phillips, DC, PhD,
Shawn P. Phelan, DC, Eugene A. Lewis, DC, MPH,
Richard C. Armstrong, MS, DC,
Maria Vassilaki, MD, MPH, PhD

Office of Public Health Studies,
University of Hawai`i at M?noa,
Honolulu, HI.


OBJECTIVES:   The purpose of the study was to compare utilization and charges generated by medical doctors (MD), doctors of chiropractic (DC) and physical therapists (PT) by patterns of care for the treatment of low back pain in North Carolina.

METHODS:   This was an analysis of low-back-pain-related closed claim data from the North Carolina State Health Plan for Teachers and State Employees from 2000 to 2009. Data were extracted from Blue Cross Blue Shield of North Carolina for the North Carolina State Health Plan using International Classification of Diseases, 9th Revision diagnostic codes for:

uncomplicated low back pain   (ULBP) and
complicated low back pain   (CLBP).

RESULTS:   Care patterns with single-provider types and no referrals incurred the least charges on average for both ULBP and CLBP. When care did not include referral providers or services, for ULBP, MD and DC care was on average $465 less than MD and PT care. For CLBP, MD and DC care averaged $965 more than MD and PT care. However, when care involved referral providers or services, MD and DC care was on average $1600 less when compared to MD and PT care for ULBP and $1885 less for CLBP. Risk-adjusted charges (available 2006-2009) for patients in the middle quintile of risk were significantly less for DC care patterns.

There are more articles like this @ our:

Low Back Pain and Chiropractic Page

(more…)

Tracking Low Back Problems in a Major Self-Insured Workforce: Toward Improvement in the Patient’s Journey

By |July 31, 2014|Chiropractic Care, Cost-Effectiveness|

Tracking Low Back Problems in a Major Self-Insured
Workforce: Toward Improvement in the Patient’s Journey

The Chiro.Org Blog


SOURCE:   J Occup Environ Med. 2014 (Jun);   56 (6):   604-620

Allen, Harris PhD; Wright, Marcia PharmD; Craig, Terri PharmD; Mardekian, Jack PhD; Cheung, Raymond PhD; Sanchez, Robert PhD; Bunn, William B. III MD, JD, MPH; Rogers, William PhD

From the Harris Allen Group, LLC (Dr Allen), Brookline, Mass; US Medical Affairs (Dr Wright), Pfizer Integrated Health, Overland Park, Kans; Pfizer Primary Care Medical Affairs (Dr Craig), Lincoln, Nebr; Pfizer Inc (Dr Mardekian), New York; Pfizer Integrated Health (Drs Cheung and Sanchez), New York; Health, Safety, Security & Productivity, Navistar, Inc (Dr Bunn)


This comprehensive new study from the Journal of Occupational and Environmental Medicine reveals that chiropractic care costs significantly less than other forms of low back care, and appears to comply with guideline recommendations more closely than than any of the other 4 comparison groups.

The authors came to these conclusions after an exhaustive analysis of an integrated database belonging to a giant, self-insured Fortune 500 manufacturer covering nine years of claims They evaluated the direct and indirect costs of LBP for all employees, looking in-depth at personnel characteristics, and medical, behavioral health, pharmaceutical, Workers Comp costs, disability, absenteeism, and lost productivity during the 2001 to 2009 period.

Thanks to Dynamic Chiropractic for some of the following comments. Make sure to read their full article!

The study had four objectives:

  1. Identify all active employees reporting a back problem diagnosis during the study period.
  2. Define and classify their initial patterns of medical care and use of Rx medication.
  3. Track the effect of these patterns on direct and indirect cost outcomes.
  4. Further stratify these treatment patterns by measures of congruence with the previously described guideline aspects for LBP care and determine the effect on cost outcomes.

Through their database review, the authors identified five specific care patterns that were typical of employee experiences

  1. Information and Advice (“TalkInfo”):
           information gathering, office visit consults, lab tests, imaging (X-ray, ultrasound, CT, or MRI)
           but no other procedures.
           (59 percent of employees).

  2. Complex Medical Management (Complex MM):
           physician visits for nerve blocks, surgeries, or comparable procedures
           (2 percent of employees).

  3. Chiropractic (Chiro):
           more than one visit to a DC.
           (11 percent of employees)

  4. Physical therapy (PT):
           more than one visit to a PT.
           (11 percent of employees)

  5. “Dabble”:
           episodes with at most one visit for physician, chiropractic, or PT care,
           or at most one visit to two or more of these categories.
           (17 percent of employees)

The average overall costs for care were a real eye opener

Low Back/Neuro (three-year total)

(more…)