Abstract
BackgroundLow back pain (LBP) imposes a costly burden upon patients, healthcare insurers, and society overall. Spinal manipulation as practiced by chiropractors has been found be cost-effective for treatment of LBP, but there is wide variation among chiropractors in their approach to clinical care, and the most cost-effective approach to chiropractic care is uncertain. To date, little has been published regarding the cost effectiveness of different approaches to chiropractic care. Thus, the current study presents a cost comparison between chiropractic approaches for patients with acute or subacute care episodes for low back pain.MethodsWe employed a retrospective cohort design to examine costs of chiropractic care among patients diagnosed with acute or subacute low back pain. The study time period ranged between 07/01/2016 and 12/22/2017. We compared cost outcomes for patients of two cohorts of chiropractors within health care system: Cohort 1) a general network of providers, and Cohort 2) a network providing conservative evidence-based care for rapid resolution of pain. We used generalized linear regression modeling to estimate the comparative influence of demographic and clinical factors on expenditures.ResultsA total of 25,621 unique patients were included in the analyses. The average cost per patient for Cohort 2 (mean allowed amount $252) was lower compared to Cohort 1 (mean allowed amount $326; 0.77, 95% CI 0.75–0.79, p < .001). Patient and clinician related factors such as health plan, provider region, and sex also significantly influenced costs.ConclusionsThis study comprehensively analyzed cost data associated with the chiropractic care of adults with acute or sub-acute low back pain cared by two cohorts of chiropractic physicians. In general, providers in Cohort 2 were found to be significantly associated with lower costs for patient care as compared to Cohort 1. Utilization of a clinical model characterized by a patient-centered clinic approach and standardized, best-practice clinical protocols may offer lower cost when compared to non-standardized clinical approaches to chiropractic care.
Highlights
In the United States (US), low back pain (LBP) imposes a costly burden upon patients, healthcare insurers, and society overall
Current evidence-based clinical guidelines for first-line treatment of low back pain recommend avoidance of opioid prescribing in favor of non-pharmacological therapies, including spinal manipulation, which is widely provided by chiropractors [5]
Within the scope of the larger project, the objective of the present study was to compare expenditures for the treatment of acute or sub-acute care episodes for Low back pain (LBP) across the two tiers of the chiropractic provider network, to determine if a patient-centric, center of excellence model resulted in lower costs
Summary
In the United States (US), low back pain (LBP) imposes a costly burden upon patients, healthcare insurers, and society overall. A systematic review published in 2008 estimated that expenditures for clinical care of patients with LBP ranged from $12 to $91 billion [1]. Current evidence-based clinical guidelines for first-line treatment of low back pain recommend avoidance of opioid prescribing in favor of non-pharmacological therapies, including spinal manipulation, which is widely provided by chiropractors [5]. Low back pain (LBP) imposes a costly burden upon patients, healthcare insurers, and society overall. The current study presents a cost comparison between chiropractic approaches for patients with acute or subacute care episodes for low back pain
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