Long-Term Medicare Costs Associated With Opioid Analgesic Therapy vs Spinal Manipulative Therapy for Chronic Low Back Pain in a Cohort of Older Adults |
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| Affiliation: | 1. Health Services Research, Southern California University of Health Sciences, Whittier, California;2. Eastern Medicine Department, Southern California University of Health Sciences, Whittier, California;3. The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire;4. Southern California University of Health Sciences, Whittier, California;1. National University of Health Sciences, Lombard, Illinois;2. Council on Chiropractic Education, Scottsdale, Arizona;3. National Board of Chiropractic Examiners, Greeley, Colorado;4. National Chiropractic Mutual Insurance Company, Clive, Iowa;5. Federation of Chiropractic Licensing Boards, Greeley, Colorado;6. Association of Chiropractic Colleges, Bethesda, Maryland;7. University of Bridgeport, Bridgeport, Connecticut;1. Department of Sports Science and Clinical Biomechanics, Odense, Denmark;2. Private practice, Valby, Denmark;1. Research Department, National University of Health Sciences, Lombard, Illinois;2. Private Practice, Wheaton, Illinois;3. Private Practice, Charlottesville, Virginia;1. Département de Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada;2. Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark;3. Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada;4. Institute for Disability and Rehabilitation Research, Ontario Tech University, Toronto, Ontario, Canada;5. Chiropractic Knowledge Hub, Odense, Denmark |
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| Abstract: | ObjectivesThe purpose of this study was to compare Medicare healthcare expenditures for patients who received long-term treatment of chronic low back pain (cLBP) with either opioid analgesic therapy (OAT) or spinal manipulative therapy (SMT).MethodsWe conducted a retrospective observational study using a cohort design for analysis of Medicare claims data. The study population included Medicare beneficiaries enrolled under Medicare Parts A, B, and D from 2012 through 2016. We assembled cohorts of patients who received long-term management of cLBP with OAT or SMT (such as delivered by chiropractic or osteopathic practitioners) and evaluated the comparative effect of OAT vs SMT upon expenditures, using multivariable regression to control for beneficiary characteristics and measures of health status, and propensity score weighting and binning to account for selection bias.ResultsThe study sample totaled 28,160 participants, of whom 77% initiated long-term care of cLBP with OAT, and 23% initiated care with SMT. For care of low back pain specifically, average long-term costs for patients who initiated care with OAT were 58% lower than those who initiated care with SMT. However, overall long-term healthcare expenditures under Medicare were 1.87 times higher for patients who initiated care via OAT compared with those initiated care with SMT (95% CI 1.65-2.11; P < .0001).ConclusionsAdults aged 65 to 84 who initiated long-term treatment for cLBP via OAT incurred lower long-term costs for low back pain but higher long-term total healthcare costs under Medicare compared with patients who initiated long-term treatment with SMT. |
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