title: Cost-effectiveness of chiropractic care versus self-management in patients with musculoskeletal chest pain.
abstract: To assess whether primary sector healthcare in the form of chiropractic care is cost-effective compared with self-management in patients with musculoskeletal chest pain, that is, a subgroup of patients with non-specific chest pain.
  
  
  
  115 adults aged 18-75 years with acute, non-specific chest pain of musculoskeletal origin were recruited from a cardiology department in Denmark. After ruling out acute coronary syndrome and receiving usual care, patients with musculoskeletal chest pain were randomised to 4 weeks of community-based chiropractic care (n=59) or to a single information session aimed at encouraging self-management as complementary to usual care (n=56). Data on resource use were obtained from Danish national registries and valued from a societal perspective. Patient cost and health-related quality-adjusted life years (QALYs; based on EuroQol five-dimension questionnaire (EQ-5D) and Short Form 36-item Health Survey (SF-36)) were compared in cost-effectiveness analyses over 12 months from baseline. Mean costs were €2183 lower for the group with chiropractic care, but not statistically significant (95% CI -4410.5 to 43.0). The incremental cost-effectiveness ratio suggested that chiropractic care was cost-effective with a probability of 97%, given a threshold value of €30 000 per QALY gained. In both groups, there was an increase in the health-related quality of life, and the mean increases were similar over the 12-month evaluation period. The mean differences in QALYs between the groups were negligible.
  
  
  
  Chiropractic care was more cost-effective than self-management. Therefore, chiropractic care can be seen as a good example of a targeted primary care approach for a subgroup of patients with non-specific chest pain.
  
  
  
  NCT00462241.
authors.affiliation: Nordic Institute of Chiropractic and Clinical Biomechanics , Odense M , Denmark.
authors.forename: Mette Jensen
authors.identifier: 0000-0003-0297-8267
authors.initials: MJ
authors.lastname: Stochkendahl
authors.affiliation: Department of Public Health , Centre for Health Economics Research (COHERE), University of Southern Denmark , Odense C , Denmark.
authors.forename: Jan
authors.initials: J
authors.lastname: Sørensen
authors.affiliation: Center of Medical Biometry and Medical Informatics, Institute of Medical Biometri and Medical Informatics, University Medical Center Freiburg , Freiburg , Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Vach
authors.affiliation: Nordic Institute of Chiropractic and Clinical Biomechanics , Odense M , Denmark.
authors.forename: Henrik Wulff
authors.initials: HW
authors.lastname: Christensen
authors.affiliation: Department of Nuclear Medicine , Odense University Hospital , Odense C , Denmark.
authors.forename: Poul Flemming
authors.initials: PF
authors.lastname: Høilund-Carlsen
authors.affiliation: Nordic Institute of Chiropractic and Clinical Biomechanics, Odense M, Denmark; Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense C, Denmark.
authors.forename: Jan
authors.initials: J
authors.lastname: Hartvigsen