June 26, 2012 — Neck pain is very common and creates a heavy cost on the American healthcare system. It affects approximately 14 percent of the population yearly.
Yet, the current treatment for neck pain is often uncoordinated, disorganized, and costly. Most sufferers will consult their medical doctor, receiving muscle relaxant, anti-inflammatory or pain medications, or if that fails, a referral for physical therapy or traction.
After repeated failures, frustrated chronic neck pain sufferers may turn to such alternatives as chiropractors, naturopaths, acupuncture, or massage. Each approach has its successes — and its failures. Researchers are beginning to look into ways to increase the patient’s health and satisfaction, while hopefully reducing costs.
Niteesh Choudhry, MD, PhD, of Harvard Medical School and Arnold Milstein, MD, MPH, of Mercer Health and Benefits examined the costs and benefits of the various health care approaches to treating neck pain. The full Mercer Report can be accessed at .
In order to evaluate overall treatment effectiveness and costs, researchers use the Quality Adjusted Life Year (QALY) to compare outcomes. A value of 1 would be symptom-free or “perfect” health, a 0 is death, and 0.5 means moderate pain which limits some self-care abilities. The total costs of a treatment that yields an additional year of ideal health determines the cost per QALY. This incremental cost-effectiveness ratio can then be used to determine the comparative value of various treatments. Interventions with cost-effectiveness ratios below $50000 to $100000 per QALY are generally considered to be cost-effective.
Choudhry and Milstein reported in the Mercer Report that medical physician care for neck pain cost $579 (not including muscle relaxant, anti-inflammatory or pain medications) with an efficacy (QALY) of 0.77. Physiotherapy-led exercise had an efficacy of 0.79 at a cost of $952.
This results in an incremental cost effectiveness ratio of $18,665 (increased cost divided by increased efficacy, numbers have been rounded). This is well below the $50,000 to $100,000 threshold for being acceptable as cost-effective. Chiropractic care had an efficacy of 0.82 at a cost of only $277, resulting in an incremental cost effectiveness ratio of negative $6,035. Not only was chiropractic more effective, it resulted in a greatly reduced cost to achieve this effectiveness!
Because sufficiently detailed drug costs were lacking, drug expenditures were not included in the analysis. This would very likely have increased the medical costs compared to the Chiropractic costs, further increasing the cost savings seen in Chiropractic care.
J G Moellendorf, DC, ND, LCP, notes, “What makes this information especially significant is that we have two highly respected medical researchers concluding that seeing a Chiropractor for neck pain is not only more effective, but less costly than other forms of treatment!”
To see just how cost efficient chiropractic care was, Choudhry and Milstein found that by doubling the fees for chiropractic care, the savings were only reduced from $6,035 to $5,995. If the costs were increased by five times, the savings would still be $5,875 compared to medical care (medication costs not included). If exercise therapy was done by Chiropractors rather than by physical therapists, the 1 year costs would drop to $464, saving $114 per patient.
The Mercer Report also noted the findings of researchers Nelson, Metz, and LaBrot who observed that when chiropractic care was utilized, there was reduced use of x-ray, MRI, CT scan, hospitalization, and surgery; resulting in substantial cost savings long term.
It was observed by the Mercer Report that nearly 50 percent of chronic spinal pain sufferers consult a chiropractor for care. Chiropractic was found to be more effective than other modalities in treating neck pain. When combined with other modalities such as exercise, it was even more effective.