A systematic review comparing the costs of chiropractic care to other interventions for spine pain in the United States

Abstract

BackgroundAlthough 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.MethodsA 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.ResultsThe search uncovered 1276 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.ConclusionsAlthough 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-1140-5) contains supplementary material, which is available to authorized users.

Exploring supervised machine learning approaches to predicting Veterans Health Administration chiropractic service utilization

“…Conservative interventions for spinal pain conditions have been associated with lower healthcare costs and improvements in pain status in different clinical populations, including veterans [5][6][7][8][9]. Veterans with musculoskeletal pain conditions, especially those of chronic nature, often utilize non-pharmacological pain management recommended by clinical practice guidelines, including U.S. Department of Veterans Affairs (VA) chiropractic care [10][11][12][13].…”

Interactions between analgesic drug therapy and mindfulness-based interventions for chronic pain in adults: protocol for a systematic scoping review

“…(85; 86) However, the systematic review found that in studies that also reported on clinical outcomes, chiropractic care was less cost-effective than care provided by family physicians. (85) With respect to specific interventions, one recent medium-quality review explored the effects of patientprovider communication on pain and found that positive suggestions (e.g., suggesting that a particular treatment will result in positive outcomes) had a small effect on reducing pain, whereas emotional care (e.g., efforts to empathize with the patient) interventions were found to have no effect on reported levels of pain. (87) The same review found that procedural preparations (e.g., information giving, behavioural instruction, CBT, and relaxation) were generally effective for reducing pain.…”

The schism in chiropractic through the eyes of a 1st year chiropractic student

“…Given costly surgical alternatives [ 100 ] or addictive opioids [ 101 ], increased utilisation of chiropractic services represents a proven, cost saving option for the management of musculoskeletal disease.…”