Cost comparison of osteopathic manipulative treatment for patients with chronic low back pain

Abstract

Chronic low back pain (cLBP) is the second leading cause of disability in the United States, with significant physical and financial implications. Development of a multifaceted treatment plan that is cost effective and optimizes patients' ability to function on a daily basis is critical. To date, there have been no published prospective studies comparing the cost of osteopathic manipulative treatment to that of standard care for patients with cLBP. To contrast the cost for standard of care treatment (SCT) for cLBP with standard of care plus osteopathic manipulative treatment (SCT + OMT). This prospective, observational study was conducted over the course of 4 months with two groups of patients with a diagnosis of cLBP. Once consent was obtained, patients were assigned to the SCT or the SCT + OMT group based on the specialty practice of their physician. At enrollment and after 4 months of treatment, all patients in both groups completed two questionnaires: the 11 point pain intensity numerical scale (PI-NRS) and the Roland Morris Disability Questionnaire (RMDQ). Cost data was collected from the electronic medical record of each patient enrolled in the study. Chi-square (χ2Yates) tests for independence using Yates' correction for continuity were performed to compare the results for each group. There was a total of 146 patients: 71 (48.6%) in the SCT + OMT group and 75 (51.4%) in the SCT group. The results showed no significant differences between the mean total costs for the SCT + OMT ($831.48 ± $553.59) and SCT ($997.90 ± $1,053.22) groups. However, the utilization of interventional therapies (2; 2.8%) and radiology (4; 5.6%) services were significantly less for the SCT + OMT group than the utilization of interventional (31; 41.3%) and radiology (17; 22.7%) therapies were for the SCT group (p<0.001). Additionally, the patients in the SCT + OMT group were prescribed fewer opioid medications (15; 21.1) than the SCT (37; 49.3%) patients (p.001). Patients in the SCT group were approximately 14.7 times more likely to have received interventional therapies than patients in the SCT + OMT group. Likewise, the patients in the SCT group were approximately four times more likely to have received radiological services. Paired t tests comparing the mean pre- and 4 month self reported pain severity scores on the RMDQ for 68 SCT + OMT patients (9.91 ± 5.88 vs. 6.40 ± 5.24) and 66 SCT patients (11.44 ± 6.10 vs. 8.52 ± 6.14) found highly significant decreases in pain for both group (<0.001). The mean total costs for the SCT and SCT + OMT patients were statistically comparable across 4 months of treatment. SCT + OMT was comparable to SCT alone in reducing pain and improving function in patients with chronic low back pain; however, there was less utilization of opioid analgesics, physical therapy, interventional therapies, radiologic, and diagnostic services for patients in the SCT + OMT group.