RESEARCH: Cost Effectiveness
Written by Craig Benton, DC   
Wednesday, April 30, 2014 08:42 PM
So it seems like every study done so far demonstrates that chiropractic care is more cost effective than medical care except for one study.  That was the Medicare chiropractic demonstration project which showed chiropractic to be more costly than medical care but that was only in one area of the country the Greater Chicago Area.
 
Here is a paper which appeared in JMPT last year.  It states that the costs in Chicago blew away the stats for Medicare.  It states after the Medicare Demonstration Project was done that costs were still 17% higher for chiropractic Medicare in the Chicago area, but if you remove the Chicago area we are less expensive.
 

http://www.jmptonline.org/article/S0161-4754(13)00177-2/fulltext

This first review is a narrative review which gives it opinion on research.  It is quite interesting despite the majority of clinical guidelines recommending spinal manipulation for the treatment of acute non specific lower back pain only 2% of PCP refer to chiropractors.  This is called the Know-Do-Gap in evidence based medicine.  The gap between knowing what to do and what is done in practice.  This found cost for episodes of care initiated with a DC were 40% less than an MD initiated care.


This next study states that chronic back pain is on the rise.  The research shows that 94% of chronic back pain patient seek some type of healthcare, and that costs are up 129% for the treatment of chronic pain.  (should we market these people?)  In the Veterans Administration they showed that patients who sought multidisciplinary care had more pain free days, or better function,  less depression, and helped in the withdraw of chronic opioid use.


This study showed that patients who used chiropractors did not increase healthcare costs.  It shows that chiropractic patients average about $424 lower costs for back pain than medical groups and $796 less costs in overall healthcare costs.  The questions to be answered is does chiropractic lower healthcare costs or do healthier individuals seek out chiropractic care?

zhttp://www.ncbi.nlm.nih.gov/pubmed/23132198

This study showed that about $12 billion was spent on CAM therapy in 2007 and 70% of the spending was attributed to 25% of the patients.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3523202/

This study shows that expenditures for medical care from 1999-2008 increased significantly while expenditures for chiropractic and physical therapy were pretty stable.  The average chiropractic claim in 2007 was $662.  Physical therapists were all over the place with a high of $1542 in 2002.  They believe one reason chiropractic has remained stable is the limitations placed upon it by Medicare.  Most of the increased spending was attributed to specialists and diagnostic testing.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3423501/

This study shows that CAM treatments are effective in the short term for neck and back problems and cheaper than physical therapy.

http://www.ncbi.nlm.nih.gov/pubmed/22203884

Here is one that was funded by Liberty Mutual Insurance and they found that disability was higher for physician or physical therapy services than chiropractic.

http://www.ncbi.nlm.nih.gov/pubmed/21407100

This study found cost effectiveness for clinical guideline endorsed treatment of subacute and chronic lower back pain with spinal manipulation.

http://www.ncbi.nlm.nih.gov/pubmed/21229367

This study showed that CAM patients had lower overall healthcare costs.  They had higher outpatient costs but lower inpatient and imaging costs.

http://www.ncbi.nlm.nih.gov/pubmed/2042321

In this study of an HMO it found that chiropractic and primary care provider costs were about equal but when there was a referral to a specialist costs skyrocketed.

http://www.ncbi.nlm.nih.gov/pubmed/20004800

Ok this is the last one.  I also have about 5-6 more if you want them but I can getting tired of telling you the same thing over and over.  This study basically states that same thing as a previous study.  Patients who choose chiropractic care have lower overall healthcare costs compared to patients that did not visit a chiropractor.

http://www.ncbi.nlm.nih.gov/pubmed/15477432

So out of these 11 studies only one showed that chiropractic was more expensive than medical care and that one was for the Medicare Demonstration Project.