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.

Keywords: Analgesics; Cervical pain; Cost analysis; Medicare; Primary care physicians; Rehabilitation; Spinal manipulation.