A systematic review comparing the costs of chiropractic care to other interventions for spine pain in the United States.
BACKGROUND
Although chiropractors in the United States (US) have long suggested that their approach to managing spine pain is less costly than other health care providers (HCPs), it is unclear if available evidence supports this premise.


METHODS
A systematic review was conducted using a comprehensive search strategy to uncover studies that compared health care costs for patients with any type of spine pain who received chiropractic care or care from other HCPs. Only studies conducted in the US and published in English between 1993 and 2015 were included. Health care costs were summarized for studies examining: 1. private health plans, 2. workers' compensation (WC) plans, and 3. clinical outcomes. The quality of studies in the latter group was evaluated using a Consensus on Health Economic Criteria (CHEC) list.


RESULTS
The search uncovered 1276 citations and 25 eligible studies, including 12 from private health plans, 6 from WC plans, and 7 that examined clinical outcomes. Chiropractic care was most commonly compared to care from a medical physician, with few details about the care received. Heterogeneity was noted among studies in patient selection, definition of spine pain, scope of costs compared, study duration, and methods to estimate costs. Overall, cost comparison studies from private health plans and WC plans reported that health care costs were lower with chiropractic care. In studies that also examined clinical outcomes, there were few differences in efficacy between groups, and health care costs were higher for those receiving chiropractic care. The effects of adjusting for differences in sociodemographic, clinical, or other factors between study groups were unclear.


CONCLUSIONS
Although cost comparison studies suggest that health care costs were generally lower among patients whose spine pain was managed with chiropractic care, the studies reviewed had many methodological limitations. Better research is needed to determine if these differences in health care costs were attributable to the type of HCP managing their care.
Spine Research LLC, 540 Main Street #7, Winchester, MA, 01890, USA. simon@spine-research.com.
Simon
S
Dagenais
World Spine Care, Santa Ana, CA, USA. odanebrady@gmail.com.
O'Dane
O
Brady
World Spine Care, Santa Ana, CA, USA. haldemanmd@aol.com.|Department of Neurology, College of Medicine, University of California, Irvine, USA. haldemanmd@aol.com.|Department of Epidemiology, School of Public Health, University of California, Los Angeles, USA. haldemanmd@aol.com.
Scott
S
Haldeman
Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada. pranlalmanga@yahoo.ca.
Pran
P
Manga
D000328:Adult; D001416:Back Pain / Q000628:therapy*; D002684:Chiropractic / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D014481:United States; D014942:Workers' Compensation