Comparative Cost Analysis of Neck Pain Treatments for Medicare Beneficiaries

Comparative Cost Analysis of Neck Pain Treatments for Medicare Beneficiaries

Archives of Physical Medicine and Rehabilitation
May 2025; Vol. 106; No. 5; pp. 801-804

Brian R. Anderson, DC, PhD; Todd A. MacKenzie, PhD; Leah M. Grout, PhD, MPH; James M. Whedon, DC, MS; from Palmer College of Chiropractic, the Geisel School of Medicine at Dartmouth College, and Southern California University of Health Sciences.

The objective of this study was to evaluate cost outcomes of initial treatment strategies for new neck pain (NP) episodes among Medicare beneficiaries from 291,604 patients. It is a retrospective cohort study using Medicare Part A [hospital visits], B [doctor visits], and D [prescription drugs] claims data.

Three cohorts were developed based on the index visit provider:

• Chiropractic for spinal manipulative therapy (SMT)
• Primary care with prescription analgesics (PCP [+A])
• Primary care without analgesics (PCP [-A])

The authors added up the total (Parts A + B + D) Medicare costs over 24 months.

Analgesic medications included non-steroidal anti-inflammatory drugs and opioids. All other medications were classified as non-analgesics.

Medicare restricts reimbursement for chiropractic services to only SMT.

This study aims to examine the long-term costs associated with different initial care strategies for new NP episodes among Medicare beneficiaries.

KEY POINTS FROM THIS ARTICLE:

1) “Neck pain (NP) and low back pain represent the third largest health care expenditure category among 155 conditions.”

• Medicare has experienced a 6-fold increase in spending for these conditions, indicating a “growing reliance on high-cost interventions.”

2) “A recent review of NP treatment guidelines [2019] indicates a consensus supporting the use of manipulation or mobilization [for nonspecific neck pain].”

3) A prior study found [Article Review 28-24, Cost of Chiropractic Versus Medical Management of Adults with Spine-related Musculoskeletal Pain]:

• Chiropractic care is more economical than medical management.
• “Cost reductions in the chiropractic group were attributed to decreased utilization of imaging studies, prescription opioids, surgeries, hospitalizations, injections, specialist visits, and emergency department visits.” [Important]

4) Findings From This Study:

• SMT resulted in a 36% reduction in neck pain costs (Part B).
• SMT resulted in a 13% reduction in prescription analgesic costs (Part D).
• SMT resulted in a 2% reduction of non-analgesic costs (Part D).
• “The most notable cost differences were observed in Part A, where SMT was associated with approximately $435 lower total costs and $282 lower NP-specific costs than primary care without analgesics.”

5) Conclusions:

• For older adults with new NP episodes, the initial SMT is associated with lower health care costs, particularly for Part A total and NP-related claims, than PCP-related strategies.
• “These findings suggest potential for health care savings based on the initial treatment choice.” [Key Point]

We have reviewed these studies that support this study:

Article Review 5-18:
A Systematic Review Comparing the Costs of Chiropractic Care to Other Interventions for Spine Pain in the United States

Article Review 6-18:
Cost of Care for Common Back Pain Conditions Initiated with Chiropractic Doctor vs. Medical Doctor/Doctor of Osteopathy as First Physician

Article Review 42-20:
Cost-Efficiency and Effectiveness of Including Doctors of Chiropractic to Offer Treatment Under Medicaid

Article Review 28-24:
Cost of Chiropractic Versus Medical Management of Adults with Spine-related Musculoskeletal Pain