Guest author - Justin Copeland, DC
Weighing one’s options with regards to health always results in a comparison of value. Does the benefit of undergoing a certain treatment or therapy add enough value to justify the costs? This question whether spoken aloud or rationalized internally is at the forefront of each decision with regards to healthcare. The same holds true for chiropractic treatment.
Instances of low back pain and neck pain make up a significant portion of medical conditions that are treated within the U.S. In fact, “low back pain alone accounts for 2% of all physician office visits; only routine examinations, hypertension and diabetes” account for more.(1) If spinal conditions and specifically, musculoskeletal spinal conditions make up such a large piece of the healthcare pie then the cost-effectiveness of therapies that treat these conditions should be weighed more heavily.
A standard measurement of effectiveness within the healthcare setting is deemed quality-adjusted life years (QALYs). When a simple calculation in which the total cost of care per episode (a single neck pain episode or back pain episode) is divided by the QALY of that care, the standard for assessing the value of healthcare is determined as dollars per QALY units. Ratios below $50,000-$100,000 per QALY are considered to be cost-effective. (1)
Applying these concepts to two high-quality randomized control trials completed in Europe show that chiropractic care for both neck pain and low back pain is remarkably cost-effective in comparison to medical physician care (MD, PT, DO and others). A single episode of low back pain as treated by medical physician care has an average cost of $2,355. A single episode of low back pain as treated by a chiropractor is only $75 more than medical physician care. However the efficacy of treatment with regards to chiropractic care and low back pain is measured at .659 QALYs whereas the efficacy of medical physician care for this same ailment is measured at .618 QALYs. The large discrepancy of success between these two interventions results in a cost-effectiveness ratio of $1,847 (Remember, any ratio less than $50,000 is considered cost-effective). This comparison renders chiropractic care as extremely cost-effective when compared to the most widely-utilized treatments for low back pain.(1)
The cost-effectiveness of treatments for neck pain is no comparison at all. Chiropractic treatment not only has a higher efficacy (.82 QALYs to .77 QALYs) but it also allows for a cost savings of $302 per patient per episode. In fact, chiropractic care is still cost saving in contrast to medical physician care if the fee per chiropractic visit were increased five-fold!(1)
While the internal deliberation of cost vs. perceived value rages on with regards to most healthcare treatments, the cost-effectiveness debate of chiropractic care for low back pain and neck pain is hardly a debate at all.