Cost Effectiveness Studies

It was estimated that 1992 low back pain costs in the US were a staggering $60 billion when production lost was taken into consideration. Research has indicated that low back pain disability is growing 14 times faster than the population. It's the leading cause of disability and morbidity in middle-aged persons, and is the most expensive source of workers' compensation costs in North America. In the 30-50 age group, low back pain is the single most expensive health care problem.

The escalating costs associated with low back pain have prompted legislators, policy makers and insurance companies to investigate cost-containment strategies. As you will see in the following studies, chiropractic care has been consistently identified as one of the most effective and cost effective treatments for the management of many low back conditions, in addition to a number of other neuromusculoskeletal disorders. Moreover, the volume of scientific evidence now being compiled makes a compelling case for the use of chiropractic as a means of controlling the escalating costs of our overburdened health care system.

    Prevalence of Selected Impairments. United States - 1971. National Center for Health Statistics, Hyattsville, Maryland - 1975, DHHS Publication No. (PHS)75-1526 (Series 10, No. 9) and 1981 DHHS Publication No. (PHS) 87-1587 (Series 10, No. 159)

    Back Injuries in Industry: A Retrospective Study Part I Overview and Cost Analysis. Spengler et al. Spine, 1986 - 11(3):241-245.


The following excerpts from the Canadian government commissioned study clearly indicates the cost effectiveness of chiropractic treatment over standard medical treatment:

  • "The overwhelming body of evidence shows that chiropractic management of low-back pain is more cost effective than medical management, and that many medical therapies are of questionable validity or are clearly inadequate ... Chiropractic manipulation is safer than medical management of low-back pain."
  • "There would be highly significant cost savings if more management of low-back pain was transferred from physicians to chiropractors... Users of chiropractic care have substantially lower health care costs, especially inpatient costs, than those who use medical care only."

The Effectiveness and Cost Effectiveness of Chiropractic Management of Low-Back Pain (The Manga Report). Pran Manga and Associates (1993) - University of Ottawa, Canada.



In 1988 a Utah Workers' Compensation Board study found the total treatment costs for back-related injuries cost an average of $775.30 per case when treated by a doctor of chiropractic. When injured workers received standard medical treatment as opposed to chiropractic treatment, the average cost per case was $1,665.43.

They also found the mean compensation cost paid out by the Utah Worker's Compensation Board for patients treated by medical doctors was
$668.39, while the mean compensation cost paid for patients treated by chiropractic doctors was only $68.38.

Cost per Case Analysis of Utah Industrial Back Injury Claims: Chiropractic Management vs. Medical Management for Diagnostically Equivalent Conditions. D.C. Tracts - 1989.

Cost per Case Comparison of Back Injury Claims of Chiropractic versus medical Management for Conditions with Identical Diagnostic Codes. Jarvis KB, et al. Journal of Occupational Medicine - 1991;33:847-852.



After reviewing the health insurance claims for 395,641 chiropractic and medical care patients, Miron Stano, Ph.D., lead researcher, concluded:

Those patients who receive chiropractic care, either solely or in conjunction with medical care, experienced "
significantly lower health care costs... on the order of $1,000 each over the two-year period" compared with those who received only medical care. Specifically, total insurance payments were $1,138 (30% higher) for those who elected medical care only. The lower costs for chiropractic patients were attributable both to lower inpatient and outpatient costs and indicated that "chiropractic treatment substitutes for other forms of outpatient care."

Stano/Medstat Research. Miron Stano, Ph.D. Oakland University.



An economic analysis conducted in Richmond, Virginia in 1992 found chiropractic care to be a lower cost option for back-related ailments. The researchers concluded that if chiropractic care was insured to the extent of other medical specialties, it would likely emerge as a first option for many patients with certain medical conditions. They also believed this could result in a decrease in the overall treatment costs for these conditions.

Additional research conducted by The College of William and Mary and the Medical College of Virginia in 1992 on mandated health insurance coverage and the economic impact of chiropractic coverage revealed:

  • The low cost of chiropractic is due not to its low rate of use, but to its apparently offsetting impacts on costs in the face of high rates of utilization. Chiropractic is a growing component of the health care sector, and it is widely used by the population.
  • Formal studies of the cost, effectiveness, or both of chiropractic, usually measured against other forms of treatment, show it to compare favorably with them.
  • By every test of cost and effectiveness, the general weight of evidence shows chiropractic to provide important therapeutic benefits, at economical costs. Additionally, these benefits are achieved with apparently minimal, even negligible, impacts on the costs of health insurance.
  • The conclusion of this analysis is that chiropractic mandates help make available health care that is widely used by the American public and has proven to be cost-effective.

    A Comparison of the Costs of Chiropractors versus Alternative Medical Practitioners. Dean DH, Schmidt RM. University of Richmond, Richmond, Virginia - January 13, 1992.

    Mandated Health Insurance Coverage for Chiropractic Treatment: An Economic Assessment, with Implications for the Commonwealth of Virginia. Schifrin LG. The College of William and Mary, Williamsburg, Virginia, and Medical College of Virginia, Richmond, Virginia - January 1992.



This large State of Florida study examined 10,652 patients who sustained back-related injuries on the job. Their findings revealed that individuals who received chiropractic care compared with standard medical care for similar diagnoses experienced had a (i) 51.3 percent shorter temporary total disability duration (ii) lower treatment cost by 58.8 percent ($558 vs. $1,100 per case) (iii) 20.3 percent hospitalization rate in the chiropractic care group vs. 52.2 percent rate in the medical care group.

An Analysis of Florida Workers' Compensation Medical Claims for Back Related Injuries. Wolk S. Foundation for Chiropractic Education and Research, Arlington, VA. - 1988.



In this study, 80 patients who previously received medical treatment were subsequently referred to the Silverman Chiropractic Center. Of the 80 patients, 21 percent had just been diagnosed with spinal disc problems, 12 percent had been diagnosed as requiring surgery and 5 percent had received emergency room treatment. Following chiropractic treatment, none of the patients were required to have surgery, 86 percent of the patients needed no further care, and the estimated health care savings in the group of 80 was estimated to be $250,000.

    The Av-Med Study - 1993.



In this Australian study, 1,996 workers' compensation cases were evaluated in patients who experienced work-related mechanical low back pain. It was found that those individuals who received chiropractic care for their back pain returned to work 4 times faster (6.26 days vs. 25.56 days) and had treatment that cost 4 times less ($392 vs. $1,569) than those who received treatments from medical doctors. Also, in those patients who received chiropractic care there was a significantly lower incidence of progression to a chronic low back pain status.

Mechanical Low-Back Pain: A Comparison of Medical and Chiropractic Management Within the Victorian Work Care Scheme. Ebrall, PS. Chiropractic Journal of Australia - 1992;22:47-53.


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