Valerie F. Williams, MA, MS; Leslie L. Clark, PhD, MS; Mark G. McNellis, PhD
Santa Monica, California,
United States of America.
OBJECTIVES: To estimate the cost-effectiveness to the US Veterans Health Administration (VA) of the use of complementary and integrative health (CIH) approaches by younger Veterans with chronic musculoskeletal disorder (MSD) pain.
PERSPECTIVE: VA healthcare system.
METHODS: We used a propensity score-adjusted hierarchical linear modeling (HLM), and 2010-2013 VA administrative data to estimate differences in VA healthcare costs, pain intensity (0-10 numerical rating scale), and opioid use between CIH users and nonusers. We identified CIH use in Veterans’ medical records through Current Procedural Terminology, VA workload tracking, and provider-type codes.
As part of a comprehensive geriatric assessment program, the RAND Corporation studied a subpopulation of patients who were under chiropractic care compared to those who were not and found that the individuals under continuing chiropractic care were:
Free from the use of a nursing home [95.7% vs 80.8%];
Free from hospitalizations for the past 23 years [73.9% vs 52.4%];
More likely to report a better health status;
More likely to exercise vigorously;
More likely to be mobile in the community [69.6% vs 46.8%].
Recipients of chiropractic care reported better overall health, spent fewer days in hospitals and nursing homes, used fewer prescription drugs, and were more active than the nonchiropractic patients.
Although it is impossible to clearly establish causality, it is clear that continuing chiropractic care is among the attributes of the cohort of patients experiencing substantially fewer costly healthcare interventions. 
A second review of a larger cohort of elderly patients across the United States compared direct expenditures [hospital care, physicians’ services, nursing home] between groups of patients who were under maintenance chiropractic care and those who were not.
Nearly a threefold savings of mean annual expenditures was reported as follows:
$ 3,105 : Maintenance care
$10,041 : No maintenance care 
One study involving elderly populations reviewed the consequences of implementing an on-site industrial chiropractic program which included the early detection, treatment, prevention and occupational management of musculoskeletal injuries 2 days per week.
James M. Whedon, DC, MS, Andrew W. J. Toler, MS, Louis A. Kazal, MD, Serena Bezdjian, PhD, Justin M. Goehl, DC, MS et al.
Southern California University of Health Sciences,
OBJECTIVE: Utilization of nonpharmacological pain management may prevent unnecessary use of opioids. Our objective was to evaluate the impact of chiropractic utilization upon use of prescription opioids among patients with spinal pain.
DESIGN AND SETTING: We employed a retrospective cohort design for analysis of health claims data from three contiguous states for the years 2012-2017.
SUBJECTS: We included adults aged 18-84 years enrolled in a health plan and with office visits to a primary care physician or chiropractor for spinal pain. We identified two cohorts of subjects: Recipients received both primary care and chiropractic care, and nonrecipients received primary care but not chiropractic care.
METHODS: We performed adjusted time-to-event analyses to compare recipients and nonrecipients with regard to the risk of filling an opioid prescription. We stratified the recipient populations as: acute (first chiropractic encounter within 30 days of diagnosis) and nonacute (all other patients).
Michael D. Freeman, Evan A. Katz, Scott L. Rosa, Bryan G. Gatterman, Ellen M. F. Strömmer, and Wendy M. Leith
CAPHRI School for Public Health and Primary Care,
Faculty of Health, Medicine, and Life Sciences,
Maastricht University, 6211 LM
Maastricht, The Netherlands.
BACKGROUND: Intervertebral instability is a relatively common finding among patients with chronic neck pain after whiplash trauma. Videofluoroscopy (VF) of the cervical spine is a potentially sensitive diagnostic tool for evaluating instability, as it offers the ability to examine relative intervertebral movement over time, and across the entire continuum of voluntary movement of the patient. At the present time, there are no studies of the diagnostic accuracy of VF for discriminating between injured and uninjured populations.
METHODS: Symptomatic (injured) study subjects were recruited from consecutive patients with chronic (>6 weeks) post-whiplash pain presenting to medical and chiropractic offices equipped with VF facilities. Asymptomatic (uninjured) volunteers were recruited from family and friends of patients. An ethical review and oversight were provided by the Spinal Injury Foundation, Broomfield, CO.
Department of Health Policy and Management,
Texas A&M University,
College Station, TX 77843, USA.
Low back pain (LBP) is a pandemic and costly musculoskeletal condition in the United States (U.S.). Patients with LBP may endure surgery, injections, and expensive visits to emergency departments. Some suggest that using physical therapy (PT) or chiropractic in the earlier stage of LBP reduces the utilization of expensive health services and lowers the treatment costs. Given that there are costs and benefits with each of these treatments, the remaining question is in a short period of time which of these treatments is optimal. The purpose of this study was to investigate the cost-effectiveness of chiropractic versus PT in the U.S. A decision tree analytic model was used for estimating the economic outcomes. The findings showed that the total average cost in the chiropractic group was $48.56 lower than the PT group. The findings also showed that the daily adjusted life years (DALY) in the chiropractic group was 0.0043 higher than the PT group. Chiropractic care was shown to be a cost-effective alternative compared with PT for adults with at least three weeks of LBP over six months.
KEYWORDS: Keywords: chiropractic; physical therapy; treatment outcome; low back pain; therapy; economics; patient satisfaction; recurrence; health care costs; illness