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. 2019 Aug;63(2):64-79.

Chiropractic Integration Within a Community Health Centre: A Cost Description and Partial Analysis of Cost-Utility From the Perspective of the Institution

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Free PMC article

Chiropractic Integration Within a Community Health Centre: A Cost Description and Partial Analysis of Cost-Utility From the Perspective of the Institution

Peter C Emary et al. J Can Chiropr Assoc. .
Free PMC article

Abstract

Objective: To evaluate costs and consequences of a new back pain service provided by chiropractors integrated into a Community Health Centre in Cambridge, Ontario. The study sample included 95 consecutive patients presenting between January 2014 to January 2016 with a mixture of sub-acute and chronic back pain.

Methods: A secondary cost-utility analysis was performed and conducted from the perspective of the healthcare institution. Cost-utility was calculated as cost per quality-adjusted life year (QALY) gained over a time horizon of 90 days.

Results: According to the EuroQol 5 Domain questionnaire, nearly 70% of patients improved. The mean number of treatment sessions was 8.4, and an average of 0.21 QALYs were gained at an average cost per QALY of $1,042. Seventy-seven percent of patients did not visit their primary care provider over the 90-day period, representing potential cost savings to the institution of between $2,022.23 and $6,135.82.

Conclusion: Adding chiropractic care to usual medical care was associated with improved outcomes at a reasonable cost in a sample of complex patients with sub-acute and chronic back pain. Future comparative cost-effectiveness studies are needed.

Objectif: Évaluer les coûts et les conséquences d’un nouveau service pour soulager les maux de dos offert par des chiropraticiens intégrés à un centre de santé communautaire à Cambridge, en Ontario. L’échantillon de l’étude comprenait 95 patients qui se sont présentés consécutivement entre janvier 2014 et janvier 2016 et qui étaient atteints de diverses douleurs dorsales subaiguës et chroniques.

Méthodes: Une analyse coût-utilité secondaire a été effectuée du point de vue de l’établissement de santé. Le coût-utilité a été calculé en tant que coût par année de vie ajustée en fonction de la qualité (AVAQ) obtenu sur une période de 90 jours.

Résultats: Selon les résultats du questionnaire EuroQol 5 Domain, près de 70 % des patients ont observé une amélioration de leurs symptômes. Le nombre moyen de séances de traitement était de 8,4 et une moyenne de 0,21 AVAQ a été obtenue à un coût moyen par AVAQ de 1 042 $. Soixante-dix-sept pour cent des patients n’ont pas consulté leur fournisseur de soins primaires au cours de la période de 90 jours, ce qui représente des économies potentielles de l’ordre de 2 022,23 $ à 6 135,82 $ pour l’établissement.

Conclusion: L’ajout de soins chiropratiques aux soins médicaux habituels a entraîné une amélioration des résultats à un coût raisonnable pour un échantillon de patients ayant des besoins complexes et présentant des douleurs dorsales subaiguës et chroniques. De futures études comparatives coût-efficacité sont nécessaires.

Keywords: chiropractic; community health centres; cost analysis; health services research.

Conflict of interest statement

Disclaimer: PCE is supported by research grants from McMaster University and the NCMIC Foundation for graduate studies. The other authors have no disclaimers, competing interests, or sources of support or funding to report in the preparation of this manuscript.

Figures

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Figure 1
Figure 1
The cost-effectiveness plane. The horizontal axis represents the difference in effect between the intervention of interest (e.g. chiropractic care) and the relevant alternative (e.g. the status quo or a competing program). The vertical axis represents the difference in cost. If the cost-utility ratio of the intervention of interest lies in the south-east quadrant (II) it is both more effective and less costly than the alternative (i.e. it dominates the alternative), making it an obvious choice for program adoption. The opposite is true in quadrant IV. The most common scenario is when the intervention of interest lies within the north-east quadrant (I) indicating that the program is more effective but also more costly. In quadrant III the program is less costly but also less effective. In the latter two cases a value judgement is used (within the context of scarce resources and opportunity cost20) in deciding whether or not to adopt the new program.
Figure 2
Figure 2
Paretian classification of EQ-5D patient profiles (post-chiropractic treatment).
Figure 3
Figure 3
Quality-adjusted life years gained and associated cost for individual patients during chiropractic care (pre- to post-treatment). QALY = quality-adjusted life years.

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