Comparative Cost Analysis of Neck Pain Treatments for Medicare Beneficiaries

Abstract

Objective

To evaluate longitudinal cost outcomes of initial treatment strategies for new neck pain (NP) episodes among Medicare beneficiaries.

Design

Retrospective cohort study using Medicare Part A, B, and D claims data.

Setting

Not applicable.

Participants

Medicare beneficiaries aged 65-99 years, continuously enrolled in Parts A, B, and D from 2018 to 2021, who experienced a new NP episode in 2019.

Interventions

Three cohorts were developed based on the index visit provider: chiropractic (spinal manipulative therapy [SMT]), primary care with prescription analgesics (PCP [+A]), and primary care without analgesics (PCP [−A], reference group).

Main Outcome Measures

Medicare allowed costs for total and NP-related claims (Parts A and B), and medication claims (Part D) over 24 months from the index visit.

Results

Among 291,604 older adults with NP, most were White women with few comorbidities. Compared to PCP (−A), the SMT cohort had 6% (cost ratio, 0.94; 95% CI, 0.93-0.95) lower total Medicare Part A costs, whereas the PCP (+A) cohort showed no difference. For NP-related Part A claims, PCP (+A) had 7% (0.93; 95% CI, 0.88-0.98) lower costs, whereas SMT showed no difference. The SMT cohort had 6% (0.94; 95% CI, 0.94-0.95) lower total Medicare Part B costs and 36% (0.64; 95% CI, 0.64-0.65) lower NP-related costs, whereas PCP (+A) had 2% (1.02; 95% CI, 1.01-1.02) higher total costs. The SMT had 2% (0.98; 95% CI, 0.98-0.99) lower nonanalgesic and 13% (0.87; 95% CI, 0.87-0.88) lower analgesic Part D costs; the PCP (+A) had 13% (1.13; 95% CI, 1.12-1.14) higher nonanalgesic but 14% (0.86; 95% CI, 0.86-0.87) lower analgesic costs. Propensity weighting balanced covariates among cohorts.

Conclusions

For older adults with new NP episodes, initial SMT was associated with lower health care costs, particularly for Part A total and NP-related claims, with a less pronounced effect on Part B and D claims than PCP-related strategies. These findings suggest potential for health care savings based on the initial treatment choice.