Cost-Effectiveness of Chiropractic

Efficiency of Primary Spine Care as Compared to Conventional Primary Care: A Retrospective Observational Study at an Academic Medical Center

By Frank M. Painter|January 8, 2022|Cost-Effectiveness of Chiropractic, Primary Spine Care|

Efficiency of Primary Spine Care as Compared to Conventional Primary Care: A Retrospective Observational Study at an Academic Medical Center

SOURCE: Chiropractic & Manual Therapies 2022 (Jan 6); 30 (1): 1

Serena Bezdjian, James M. Whedon, Robb Russell, Justin M. Goehl & Louis A. Kazal Jr.

Southern California University of Health Sciences,
Whittier, CA, 90604, USA.

Opioid use was 389% higher in the Medical group than the PSC group,
who’s care was provided by a Doctor of Chiropractic.

Background: Primary Spine Care (PSC) is an innovative model for the primary management of patients with spine-related disorders (SRDs), with a focus on the use of non-pharmacological therapies which now constitute the recommended first-line approach to back pain. PSC clinicians serve as the initial or early point of contact for spine patients and utilize evidence-based spine care pathways to improve outcomes and reduce escalation of care (EoC) [e.g., spinal injections, diagnostic imaging, hospitalizations, referrals to a specialist]. The present study examined 6-month outcomes to evaluate the efficiency of care for patients who received PSC as compared to conventional primary care. We h

Methods: This was a retrospective observational study. We evaluated 6-month outcomes for two groups seen and treated for an SRD between February 01, 2017 and January 31, 2020. Patient groups were comprised of N = 1,363 PSC patients (Group A) and N = 1,329 PC patients (Group B). We conducted Pearson chi-square and logistic regression (adjusting for patient characteristics that were unbalanced between the two groups) to determine associations between the two groups and 6-month outcomes.

Results: Within six months of an initial visit for an SRD, a statistically significantly smaller proportion of PSC patients utilized healthcare resources for spine care as compared to the PC patients. When adjusting for patient characteristics, those who received care from the PSC clinician were less likely within 6 months of an initial visit to be

hospitalized (OR = .47, 95% CI .23-.97),
fill a prescription for an opioid analgesic (OR = .43; 95% CI .29-.65),
receive a spinal injection (OR = .56, 95% CI .33-.95), or
have a visit with a specialist (OR = .48, 95% CI .35-.67)

as compared to those who received usual primary care.

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The Effect of Reduced Access to Chiropractic Care on Medical Service Use for Spine Conditions Among Older Adults

By Frank M. Painter|December 15, 2021|Cost-Effectiveness, Cost-Effectiveness of Chiropractic|

The Effect of Reduced Access to Chiropractic Care on Medical Service Use for Spine Conditions Among Older Adults

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther 2021 (Aug 7)

Matthew Davis, Olga Yakusheva, Haiyin Liu, Brian Anderson, Julie Bynum

University of Michigan,
400 North Ingalls, Room 4347,
Ann Arbor, MI 48109

Objective: The purpose of this study was to examine the extent to which access to chiropractic care affects medical service use among older adults with spine conditions.

Methods: We used Medicare claims data to identify a cohort of 39,278 older adult chiropractic care users who relocated during 2010-2014 and thus experienced a change in geographic access to chiropractic care. National Plan and Provider Enumeration System data were used to determine chiropractor per population ratios across the United States. A reduction in access to chiropractic care was defined as decreasing 1 quintile or more in chiropractor per population ratio after relocation. Using a difference-in-difference analysis (before versus after relocation), we compared the use of medical services among those who experienced a reduction in access to chiropractic care versus those who did not.

Results: Among those who experienced a reduction in access to chiropractic care (versus those who did not), we observed an increase in the rate of visits to primary care physicians for spine conditions (an annual increase of 32.3 visits, 95% CI: 1.4-63.1 per 1,000) and rate of spine surgeries (an annual increase of 5.5 surgeries, 95% CI: 1.3-9.8 per 1,000). Considering the mean cost of a visit to a primary care physician and spine surgery, a reduction in access to chiropractic care was associated with an additional cost of $114,967 per 1,000 beneficiaries on medical services ($391 million nationally).

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The Use of Complementary and Integrative Health

By Frank M. Painter|March 25, 2020|Alternative Medicine, Cost-Effectiveness of Chiropractic|

The Use of Complementary and Integrative Health Approaches for Chronic Musculoskeletal Pain in Younger US Veterans: An Economic Evaluation

The Chiro.Org Blog

SOURCE: PLoS One. 2019 (Jun 5); 14 (6): e0217831

Valerie F. Williams, MA, MS; Leslie L. Clark, PhD, MS; Mark G. McNellis, PhD

RAND Corporation,
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.

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Treatment of Patients with Low Back Pain

By Frank M. Painter|March 5, 2020|Cost-Effectiveness of Chiropractic|

Treatment of Patients with Low Back Pain: A Comparison of Physical Therapy and Chiropractic Manipulation

The Chiro.Org Blog

SOURCE: Healthcare (Basel). 2020 (Feb 24); 8 (1): E44

Nima Khodakarami

Department of Health Policy and Management,
Texas A&M University,
College Station, TX 77843, USA.

FROM:
Americans’ Perceptions of Chiropractic 2015

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

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Chiropractic Integration Within a Community Health Centre

By Frank M. Painter|October 7, 2019|Cost-Effectiveness of Chiropractic|

Chiropractic Integration Within a Community Health Centre: A Cost Description and Partial Analysis of Cost-utility from the Perspective of the Institution

The Chiro.Org Blog

SOURCE: J Can Chiropr Assoc. 2019 (Aug); 63 (2): 64–79

Peter C Emary, DC, MSc, Amy L Brown, DC, Douglas F Cameron, DC, and Alexander F Pessoa, DC

Private Practice,
Cambridge, ON, Canada.

OBJECTIVE: To evaluate costs and consequences of a new back pain service provided by chiropractors integrated into a Community Health Centre in Cambridge, Ontario. The study sample included 95 consecutive patients presenting between January 2014 to January 2016 with a mixture of sub-acute and chronic back pain.

METHODS: A secondary cost-utility analysis was performed and conducted from the perspective of the healthcare institution. Cost-utility was calculated as cost per quality-adjusted life year (QALY) gained over a time horizon of 90 days.

RESULTS: According to the EuroQol 5 Domain questionnaire, nearly 70% of patients improved. The mean number of treatment sessions was 8.4, and an average of 0.21 QALYs were gained at an average cost per QALY of $1,042. Seventy-seven percent of patients did not visit their primary care provider over the 90-day period, representing potential cost savings to the institution of between $2,022.23 and $6,135.82.

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Importance of the Type of Provider Seen

By Frank M. Painter|August 11, 2018|Cost-Effectiveness of Chiropractic|

Importance of the Type of Provider Seen to Begin Health Care for a New Episode Low Back Pain: Associations with Future Utilization and Costs

The Chiro.Org Blog

SOURCE: J Eval Clin Pract. 2016 (Apr); 22 (2): 247–252

Julie M. Fritz PhD PT FAPTA, Jaewhan Kim PhD, and Josette Dorius BSN MPH

Department of Physical Therapy,
College of Health,
University of Utah,
Salt Lake City, UT, USA.

Editorial Comment

This article is the perfect example of how mis-leading an Abstract can be, when it fails to reflect what the study actually reveals. (see it below)

The RESULTS portion of this Abstract only partially discusses the findings, comparing 3 different professions’ treatment, costs, and outcomes for low back pain.

In it they only mention the costs associated with medical management, while in reviewing chiropractic care vs. physical thereapy portions, they choose to emphasize:

Entry in chiropractic was associated with
an increased episode of care duration

whereas

Entry in physical therapy
no patient entering in physical therapy had surgery.

That *seems* to suggest that physical therapy *may* entail less expense, or shorter durations of care, or that chiropractic patients are more likely to end up with surgery. None of that is true. Their own Table 2 plainly reveals that chiropractic care was the least expensive form of care provided to the 3 groups.

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