Chiropractic care is an efficient and cost-effective way to treat people suffering from lower back and neck pain. And such care also can add value in terms of dollars spent as part of an employer-sponsored health care plan.
According to the report, chiropractic treatment for most cases of low back and neck pain “is likely to drive improved cost-effectiveness.” And when data is examined just for neck problems, chiropractic care can even lead to an overall reduction in U.S. health care spending.
Eye on outcomes
The findings come from an important new analysis of the cost-effectiveness of chiropractic care conducted by Niteesh K. Choudhry, M.D, PhD, an assistant professor at Harvard Medical School, and Arnold Milstein, M.D., the San Francisco-based chief physician for Mercer. Their assessment suggests that chiropractic care for the treatment of low back and neck pain is likely to produce “equal or better health outcomes” at a cost that “compares very favorably to most therapies that are routinely covered in U.S. health benefit plans.”
The mission was to first look at the results of existing U.S. reports published in peer-reviewed scientific journals, and then to analyze high-quality randomized European Union studies. The ultimate objective was to estimate the cost-effectiveness of having health insurance in the U.S. cover chiropractic care.
According to the study’s assessment of the U.S. studies and the E.U. data, “chiropractic physician care for low back and neck pain is highly cost-effective, represents a good value in comparison to medical physician care and to widely accepted cost-effectiveness thresholds.” Comparative benefits may be understated because chiropractic care generally involves less spending for costly drugs – a factor not included in the latest study.
Lower back and neck pains afflict a large portion of the population. And the tab for treating these ailments amounts to a significant slice of total health care expenditures. Annual U.S. outlays for the treatment of spine-related problems are estimated at about $85 billion based on a 65% adjustment for inflation since 1997.
Low back pain by itself accounts for 2% of all trips to a doctor’s office. Only visits for routine physical exams, or treatment of hypertension and diabetes, have a higher percentage. More than a quarter of U.S. adults surveyed in 2002 reported they had suffered from back pain in the prior 3 months, while 14% had neck pain.
Treatment options
There are a number of treatments for dealing with lower back and neck pain. The options range from rest to specified exercise routines, and, in extreme cases, surgical intervention. Chiropractic care involves the non-surgical treatment of muscular and skeletal problems, mainly by careful manipulation of the spine with attention to adjacent parts of the body. It is estimated that nearly half of all patients with persistent back pain avail themselves of some form of chiropractic treatment.
The European trial studies were considered rigorous in their methodology and, therefore, useful in providing “reasonable estimates of health outcomes” in the U.S. The analysis was based on the assumption that both relative effectiveness and the utilization of resources in this country were comparable to what was observed in the two European trials.
The report expresses the clinical and cost effectiveness of chiropractic services for low back pain and neck pain in the context of Quality Adjusted Life Years (QALYs) – a well-established metric for determining the relative value of a clinical intervention.
In general terms, a procedure or service with a dollar per QALY value of less than $50,000 to $100,000 is considered cost-effective. The authors calculated the incremental cost effectiveness ratio of chiropractic care versus medical physician care to be $1,837. In comparison, this same ratio for physiotherapy care is $49,210. This led to the conclusion that chiropractic care “compares extremely favorably to the cost-effectiveness of most widely-used therapies.”
“In combination with the existing US-based literature, our findings support the value of health insurance coverage of chiropractic care for low back and neck pain at average fees currently payable by U.S. commercial insurers,” the report concludes.
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Stephen Mittler |
