Cost Effectiveness Studies
Blue Cross Blue Shield of Tennessee (2010)
This study evaluated low back pain care for Blue Cross Blue Shield of Tennessee’s intermediate and large group fully insured population over a two-year period. This study reflect what happens when chiropractic and medical services compete on a level playing field.
The researchers were led by an actuary and evaluated low back pain care costs when the care was initiated by a doctor of chiropractic (DC) and when it was initiated by a medical doctor (MD) or and osteopath (DO) They found that costs for the chiropractic group were 40 percent lower. After factoring in the severity of the conditions the patients presented with costs were still 20% lower when care was initiated through a DC. The reseachers concluded that restricting access to chiropractic care for the treatment of low back pain causes the insurers to pain more than if there was no restriction. Their analysis calculated that had all the cases of low back pain had their treatment initiated by a DC, BCBS of Tennessess would have had an annual cost savings of $2.3 million.
Liliedahl RL, Finch MD, Axene DV, Goertz CM. Cost of Care for Common Back Pain Conditions Initiated With Chiropractic Doctor vs Medical Doctor/Doctor of Osteopathy as First Physician: Experience of One Tennessee-Based General Health Insurer. J Manipulative Physiol Ther. November - December 2010;33(9):640-643.
Center for Health Value Innovation Report (2010)
The Center for Health Value Innovation (www.vbhealth.org) is a membership organization of employers and insurance plan sponsors that “shares actionable health data, strategies and tools for better business performance.” This organization’s core mission is to align incentives for individual responsibility and corporate accountability. CHVI’s 2010 report, “Outcomes-Based Contracting™: The Value-Based Approach for Optimal Health with Chiropractic Services,” addresses the role of chiropractic services as part of the continuum of care in value-based benefit design.
After analyzing available data on clinical effectiveness and cost-effectiveness, CHVI concluded that “the addition of chiropractic coverage for the treatment of low back and neck pain at prices typically payable in US employer-sponsored health plans will likely increase value-for-dollar.”
Nayer C, Sherman B, Mahoney J. Outcomes-Based Contracting: The Value-Based Approach for Optimal Health with Chiropractic Services. St. Louis: Center for Health Value Innovation;2010.
(Summary by Daniel Redwood, D.C. Click HERE for more information.)
The Association of Complementary and Alternative Medicine Use and Health Care Expenditures for Back and Neck Problems
A total of 12,036 respondents with spine problems were included, including 4306 (35.8%) CAM users (40.8% in weighted sample). CAM users had significantly better self-reported health, education, and comorbidity compared with non-CAM users. Adjusted annual medical costs among CAM users was $424 lower (95% confidence interval: $240, $609; P<0.001) for spine-related costs, and $796 lower (95% confidence interval: $121, $1470; P = 0.021) for total health care cost than among non-CAM users. Average expenditure for CAM users, based on propensity matching, was $526 lower for spine-specific costs (P<0.001) and $298 lower for total health costs (P = 0.403). Expenditure differences were primarily due to lower inpatient expenditures among CAM users.
Brook I. Martin, PhD MPH, Mary M. Gerkovich, PhD, Richard A. Deyo, MD, MPH, et.al., The Association of Complementary and Alternative Medicine Use and Health Care Expenditures for Back and Neck Problems, Department of Orthopaedics, The Geisel School of Medicine at Dartmouth & Dartmouth-Hitchcock Medical Center, Lebanon, NH, Med Care. 2012 (Dec); 50 (12): 1029–1036
"The Martin, et al., study is important because 1) it is the first study that evaluates data from a nationally representative sample of over 12,000 patients with spine-related conditions; 2) investigators were able to control for important socioeconomic and health-related variables; and 3) additional analysis were conducted using a sophisticated statistical technique called propensity scoring, which further addresses the selection bias issue. Thus, I would consider this paper to be the most definitive work to date on expenditures for patients who seek chiropractic care for back and next problems."
Dynamic Chiropractic Article evaluating the Martin Study. Click HERE to read the whole article.