Economic evaluation of four treatments for low-back pain: Results from a randomized controlled trial

Gerald F. Kominski, Kevin C. Heslin, Hal Morgenstern, Eric L. Hurwitz, Philip I Harber

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Objective: We sought to compare total outpatient costs of 4 common treatments for low-back pain (LBP) at 18-months follow-up. Methods: Our work reports on findings from a randomized controlled trial within a large medical group practice treating HMO patients. Patients (n = 681) were assigned to 1 of 4 treatment groups, ie, medical care only (MD), medical care with physical therapy (MDPt), chiropractic care only (DC), or chiropractic care with physical modalities (DCPm). Total outpatient costs, excluding pharmaceuticals, were measured at 18 months. We did not perform a cost-effectiveness analysis because previously published findings showed no clinically meaningful difference in outcomes among the 4 treatment groups. Thirty-seven participants were lost to follow-up at 18 months, leaving a final sample size of n = 654. Results: Adjusting for covariates, DC was 51.9% more expensive than MD (P < 0.001), DCPm 3.2% more expensive than DC (P = 0.76), and MDPt 105.8% more expensive than MD (P < 0.001). The adjusted mean outpatient costs per treatment group were $369 for MD, $560 for DC, $579 for DCPm, and $760 for MDPt. Conclusions: This study is the first randomized trial to show higher costs for chiropractic care without producing better clinical outcomes, but our findings are likely to understate the costs of medical care with or without physical therapy because of the absence of pharmaceutical data. Physical therapy provided in combination with medical care and physical modalities provided in combination with chiropractic care do not appear to be cost-effective strategies for treatment of LBP; they produce higher costs without clinically significant improvements in outcome.

Original languageEnglish (US)
Pages (from-to)428-435
Number of pages8
JournalMedical Care
Volume43
Issue number5
DOIs
StatePublished - May 2005
Externally publishedYes

Fingerprint

Low Back Pain
Cost-Benefit Analysis
pain
Randomized Controlled Trials
medical care
Chiropractic
costs
evaluation
economics
Costs and Cost Analysis
Outpatients
Therapeutics
pharmaceutical
Health Care Costs
group practice
Group
Group Practice
Health Maintenance Organizations
Lost to Follow-Up
Pharmaceutical Preparations

Keywords

  • Low-back pain costs
  • Medical versus chiropractic care
  • Physical modalities
  • Physical therapy

ASJC Scopus subject areas

  • Nursing(all)
  • Public Health, Environmental and Occupational Health
  • Health(social science)
  • Health Professions(all)

Cite this

Economic evaluation of four treatments for low-back pain : Results from a randomized controlled trial. / Kominski, Gerald F.; Heslin, Kevin C.; Morgenstern, Hal; Hurwitz, Eric L.; Harber, Philip I.

In: Medical Care, Vol. 43, No. 5, 05.2005, p. 428-435.

Research output: Contribution to journalArticle

Kominski, Gerald F. ; Heslin, Kevin C. ; Morgenstern, Hal ; Hurwitz, Eric L. ; Harber, Philip I. / Economic evaluation of four treatments for low-back pain : Results from a randomized controlled trial. In: Medical Care. 2005 ; Vol. 43, No. 5. pp. 428-435.
@article{55c5ebdbb0864181a8421122d73d6aa7,
title = "Economic evaluation of four treatments for low-back pain: Results from a randomized controlled trial",
abstract = "Objective: We sought to compare total outpatient costs of 4 common treatments for low-back pain (LBP) at 18-months follow-up. Methods: Our work reports on findings from a randomized controlled trial within a large medical group practice treating HMO patients. Patients (n = 681) were assigned to 1 of 4 treatment groups, ie, medical care only (MD), medical care with physical therapy (MDPt), chiropractic care only (DC), or chiropractic care with physical modalities (DCPm). Total outpatient costs, excluding pharmaceuticals, were measured at 18 months. We did not perform a cost-effectiveness analysis because previously published findings showed no clinically meaningful difference in outcomes among the 4 treatment groups. Thirty-seven participants were lost to follow-up at 18 months, leaving a final sample size of n = 654. Results: Adjusting for covariates, DC was 51.9{\%} more expensive than MD (P < 0.001), DCPm 3.2{\%} more expensive than DC (P = 0.76), and MDPt 105.8{\%} more expensive than MD (P < 0.001). The adjusted mean outpatient costs per treatment group were $369 for MD, $560 for DC, $579 for DCPm, and $760 for MDPt. Conclusions: This study is the first randomized trial to show higher costs for chiropractic care without producing better clinical outcomes, but our findings are likely to understate the costs of medical care with or without physical therapy because of the absence of pharmaceutical data. Physical therapy provided in combination with medical care and physical modalities provided in combination with chiropractic care do not appear to be cost-effective strategies for treatment of LBP; they produce higher costs without clinically significant improvements in outcome.",
keywords = "Low-back pain costs, Medical versus chiropractic care, Physical modalities, Physical therapy",
author = "Kominski, {Gerald F.} and Heslin, {Kevin C.} and Hal Morgenstern and Hurwitz, {Eric L.} and Harber, {Philip I}",
year = "2005",
month = "5",
doi = "10.1097/01.mlr.0000160379.12806.08",
language = "English (US)",
volume = "43",
pages = "428--435",
journal = "Medical Care",
issn = "0025-7079",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Economic evaluation of four treatments for low-back pain

T2 - Results from a randomized controlled trial

AU - Kominski, Gerald F.

AU - Heslin, Kevin C.

AU - Morgenstern, Hal

AU - Hurwitz, Eric L.

AU - Harber, Philip I

PY - 2005/5

Y1 - 2005/5

N2 - Objective: We sought to compare total outpatient costs of 4 common treatments for low-back pain (LBP) at 18-months follow-up. Methods: Our work reports on findings from a randomized controlled trial within a large medical group practice treating HMO patients. Patients (n = 681) were assigned to 1 of 4 treatment groups, ie, medical care only (MD), medical care with physical therapy (MDPt), chiropractic care only (DC), or chiropractic care with physical modalities (DCPm). Total outpatient costs, excluding pharmaceuticals, were measured at 18 months. We did not perform a cost-effectiveness analysis because previously published findings showed no clinically meaningful difference in outcomes among the 4 treatment groups. Thirty-seven participants were lost to follow-up at 18 months, leaving a final sample size of n = 654. Results: Adjusting for covariates, DC was 51.9% more expensive than MD (P < 0.001), DCPm 3.2% more expensive than DC (P = 0.76), and MDPt 105.8% more expensive than MD (P < 0.001). The adjusted mean outpatient costs per treatment group were $369 for MD, $560 for DC, $579 for DCPm, and $760 for MDPt. Conclusions: This study is the first randomized trial to show higher costs for chiropractic care without producing better clinical outcomes, but our findings are likely to understate the costs of medical care with or without physical therapy because of the absence of pharmaceutical data. Physical therapy provided in combination with medical care and physical modalities provided in combination with chiropractic care do not appear to be cost-effective strategies for treatment of LBP; they produce higher costs without clinically significant improvements in outcome.

AB - Objective: We sought to compare total outpatient costs of 4 common treatments for low-back pain (LBP) at 18-months follow-up. Methods: Our work reports on findings from a randomized controlled trial within a large medical group practice treating HMO patients. Patients (n = 681) were assigned to 1 of 4 treatment groups, ie, medical care only (MD), medical care with physical therapy (MDPt), chiropractic care only (DC), or chiropractic care with physical modalities (DCPm). Total outpatient costs, excluding pharmaceuticals, were measured at 18 months. We did not perform a cost-effectiveness analysis because previously published findings showed no clinically meaningful difference in outcomes among the 4 treatment groups. Thirty-seven participants were lost to follow-up at 18 months, leaving a final sample size of n = 654. Results: Adjusting for covariates, DC was 51.9% more expensive than MD (P < 0.001), DCPm 3.2% more expensive than DC (P = 0.76), and MDPt 105.8% more expensive than MD (P < 0.001). The adjusted mean outpatient costs per treatment group were $369 for MD, $560 for DC, $579 for DCPm, and $760 for MDPt. Conclusions: This study is the first randomized trial to show higher costs for chiropractic care without producing better clinical outcomes, but our findings are likely to understate the costs of medical care with or without physical therapy because of the absence of pharmaceutical data. Physical therapy provided in combination with medical care and physical modalities provided in combination with chiropractic care do not appear to be cost-effective strategies for treatment of LBP; they produce higher costs without clinically significant improvements in outcome.

KW - Low-back pain costs

KW - Medical versus chiropractic care

KW - Physical modalities

KW - Physical therapy

UR - http://www.scopus.com/inward/record.url?scp=18844362872&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=18844362872&partnerID=8YFLogxK

U2 - 10.1097/01.mlr.0000160379.12806.08

DO - 10.1097/01.mlr.0000160379.12806.08

M3 - Article

C2 - 15838406

AN - SCOPUS:18844362872

VL - 43

SP - 428

EP - 435

JO - Medical Care

JF - Medical Care

SN - 0025-7079

IS - 5

ER -