Abstract
Objective
The purpose of this study was to determine whether use of chiropractic manipulative
treatment (CMT) was associated with lower healthcare costs among multiply-comorbid
Medicare beneficiaries with an episode of chronic low back pain (cLBP).
Methods
We conducted an observational, retrospective study of 2006 to 2012 Medicare fee-for-service
reimbursements for 72326 multiply-comorbid patients aged 66 and older with cLBP episodes and 1 of 4 treatment
exposures: chiropractic manipulative treatment (CMT) alone, CMT followed or preceded
by conventional medical care, or conventional medical care alone. We used propensity
score weighting to address selection bias.
Results
After propensity score weighting, total and per-episode day Part A, Part B, and Part
D Medicare reimbursements during the cLBP treatment episode were lowest for patients
who used CMT alone; these patients had higher rates of healthcare use for low back
pain but lower rates of back surgery in the year following the treatment episode.
Expenditures were greatest for patients receiving medical care alone; order was irrelevant
when both CMT and medical treatment were provided. Patients who used only CMT had
the lowest annual growth rates in almost all Medicare expenditure categories. While
patients who used only CMT had the lowest Part A and Part B expenditures per episode
day, we found no indication of lower psychiatric or pain medication expenditures associated
with CMT.
Conclusions
This study found that older multiply-comorbid patients who used only CMT during their
cLBP episodes had lower overall costs of care, shorter episodes, and lower cost of
care per episode day than patients in the other treatment groups. Further, costs of
care for the episode and per episode day were lower for patients who used a combination
of CMT and conventional medical care than for patients who did not use any CMT. These
findings support initial CMT use in the treatment of, and possibly broader chiropractic
management of, older multiply-comorbid cLBP patients.
Key Indexing Terms
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Article info
Publication history
Published online: February 20, 2016
Accepted:
October 13,
2015
Received in revised form:
September 24,
2015
Received:
September 17,
2015
Identification
Copyright
© 2016 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.
