Cost-effectiveness of chiropractic care versus self-management in patients with musculoskeletal chest pain

Abstract

AimsTo 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.Methods and results115 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.ConclusionsChiropractic 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.Trial registration numberNCT00462241.

Spine Care as a Framework for the Chiropractic Identity

“…It is natural for patients who have had a positive experience with chiropractic care for a spine problem to seek out the same practitioner when they develop a problem in another area of the musculoskeletal system. There is in fact good evidence that chiropractors can be helpful in managing headaches,57, 58 musculoskeletal chest pain,59, 60, 61 osteoarthritis of the hip, 62 and a range of other musculoskeletal conditions 63 …”

Cost-effectiveness of specialised manual therapy versus orthopaedic care for musculoskeletal disorders: long-term follow-up and health economic model

“…Their treatment involves a combination of manual techniques, such as spinal manipulation and mobilisation, and soft tissue techniques in combination with home exercises. There is clinical and scientific evidence from certain studies that specialised MT effectively treats back and neck pain 6 and other kinds of musculoskeletal disorders in secondary care 7 after 12 months, and a pragmatic randomised controlled trial (RCT) and health economic evaluation of naprapathic manual therapy (NMT) 8 for nonsurgical orthopaedic outpatients showed that it dominated ‘standard care’ (i.e. better outcomes at lower cost).…”

What is chiropractic?

“…Our informal search in Pubmed using the search terms “chiropractic OR chiropractor” reveals a 54% increase in publications between 2002 and 2016 (216 versus 401 publications). Hence, we have a better understanding than ever before of the education of chiropractors [ 7 , 8 ], the types of therapies used by chiropractors [ 9 – 11 ], the conditions treated by chiropractors [ 10 – 13 ], the effectiveness [ 14 – 16 ] and cost-effectiveness of chiropractic care [ 17 , 18 ], safety and side effects of chiropractic treatment [ 19 , 20 ], and settings where chiropractors function alone or in collaboration with other healthcare providers [ 21 – 23 ]. In spite of this, there is still not a clear picture of what comprises the chiropractic profession, and how chiropractors contribute to the health of individual patients and populations.…”