title: The association of complementary and alternative medicine use and health care expenditures for back and neck problems.
abstract: BACKGROUND
  Health care costs associated with use of complementary and alternative medicine (CAM) by patients with spine problems have not been studied in a national sample.
  
  
  OBJECTIVE
  To estimate the total and spine-specific medical expenditures among CAM and non-CAM users with spine problems.
  
  
  METHODS
  Analysis of the 2002-2008 Medical Expenditure Panel Survey.
  
  
  METHODS
  Adults (above 17 y) with self-reported neck and back problems who did or did not use CAM services.
  
  
  METHODS
  Survey-weighted generalized linear regression and propensity matching to examine expenditure differences between CAM users and non-CAM users while controlling for patient, socioeconomic, and health characteristics.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  CAM users did not add to the overall medical spending in a nationally representative sample with neck and back problems. As the causal associations remain unclear in these cross-sectional data, future research exploring these cost differences might benefit from research designs that minimize confounding.
authors.affiliation: Department of Orthopaedics, The Geisel School of Medicine at Dartmouth & Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA. brook.i.martin@dartmouth.edu
authors.forename: Brook I
authors.initials: BI
authors.lastname: Martin
authors.forename: Mary M
authors.initials: MM
authors.lastname: Gerkovich
authors.forename: Richard A
authors.initials: RA
authors.lastname: Deyo
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Sherman
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Cherkin
authors.forename: Bonnie K
authors.initials: BK
authors.lastname: Lind
authors.forename: Christine M
authors.initials: CM
authors.lastname: Goertz
authors.forename: William E
authors.initials: WE
authors.lastname: Lafferty
mesh_terms: D000367:Age Factors; D001416:Back Pain / Q000453:epidemiology / Q000628:therapy*; D000529:Complementary Therapies / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D019547:Neck Pain / Q000453:epidemiology / Q000628:therapy*; D012737:Sex Factors; D012959:Socioeconomic Factors