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

Mette Jensen Stochkendahl, Jan Sørensen, Werner Vach, Henrik Wulff Christensen, Poul Flemming Høilund-Carlsen, Jan Hartvigsen, Mette Jensen Stochkendahl, Jan Sørensen, Werner Vach, Henrik Wulff Christensen, Poul Flemming Høilund-Carlsen, Jan Hartvigsen

Abstract

Aims: To 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 results: 115 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.

Conclusions: Chiropractic 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 number: NCT00462241.

Figures

Figure 1
Figure 1
(A) The types of costs that were included in the analysis, and (B) the types of costs that were not included (modified from Torrance et al27). *Indicates that the service is paid by the patient, but partially reimbursed by the National Danish Health insurance. CAM, complementary and alternative medicine; ER, emergency room; GP, general practitioner.
Figure 2
Figure 2
Scatter plot of estimated joint density of incremental costs and incremental effects (quality-adjusted life years (EuroQol five-dimension questionnaire, EQ-5D)) of chiropractic care versus self-management obtained by bootstrap resampling.

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