▪ Studies Using Direct Cost Variables | | | |
□ Assendelft19 | Journal of Manipulative Physiological Therapies (1993) | Methodological review of workers' compensation-claim-based studies published from 1966 to 1990, as found on MEDLINE. | Compares methods and findings of studies, Identifies study limitations, and recommends that future studies include specifically defined cost variables and clinical outcome measures. |
□ Johnson21 | Journal of Manipulative Physiological Therapies (1989) | Review of select back and neck sprain and strain injury claimants on workers' compensation rolls in lowa in 1984. | Compares number of days lost from work and average direct costs by provider type. Clinical outcomes data presented. |
□ Li4 | Texas report of workers' compensation claims (1999) | Analysis of trends in cost per claim by provider type. | Uses average cost per service by provider type. No clinical outcomes data presented. |
□ Lipton5 | AAO [American Academy of Osteopathy] Journal (1994) | Comparison of results for subjects acting as their own retrospective controls for outcomes associated with standard care (pretreatment) and OMT (posttreatment). | Compares estimated costs of lost time at work and reduction of pain for OMT outcomes compared with previous standard treatment outcomes. Costs computed with a formula to estimate lost time at work and treatment costs. |
□ Stano22 | Journal of Manipulative Physiological Therapies (1993) | Comparison of healthcare costs by provider type to determine whether insurance restrictions on chiropractors were a factor in lower costs for chiropractic care. | Two years of claims data analyzed for subjects with one or more neuromusculoskeletal ICD-924 diagnosis codes (N=493). Study includes the cost of inpatient episodes. Reported lower costs for chiropractors. |
□ unnamed† | Hawaii report of workers' compensation claims (1994) | Report of costs per claim by provider type. Narrative observations by an independent actuarial analyst firm. | Uses claims data for the state of Hawaii. No clinical outcomes data presented. |
□ unnamed2 and unnamed3 | Colorado independent analyses of workers' compensation claims (1991-1996; 2001) | Report of trends in indemnity costs, medical costs, and total costs by provider type. | Uses claims data for the state of Colorado. Defines costs by claimant attorney fees and provider charges. No clinical outcomes data presented. |
□ Wolk20 | Journal of the American Chiropractic Association (1988) | Analysis of workers' compensation medical claims for back-related injuries. | Compares costs from claims filed in the state of Florida by provider type. No clinical outcomes data presented. |
▪ Studies Using Indirect/Imputed Cost Variables | | | |
□ Andersson9† | New England Journal of Medicine (1999) | Comparison of clinical outcomes for low back pain (OMT versus standard medical care). | Prospective, randomized study (N=155), but without blinding or control. Reported no difference in pain relief or functioning level after 12 weeks. Costs associated with less use of prescription pain medication and physical therapy among OMT patients. No cost data reported, though it is reported that the differences in costs were significant. Recommends future analysis of actual costs associated with medication and use of physical therapy. |
□ Cantier6‡ | AAO [American Academy of Osteopathy] Journal (1997) | Retrospective review of length of hospital stay (OMT versus standard medical care). | Records reviewed from 18 hospitals in 67 DRGs. Many descriptive results in this study reporting reduced length of hospital stay for patients receiving OMT during hospitalization for 16% of DRGs, with acutely psychotic patients having the largest reduction in length of stay. No cost data reported. |
□ Gamber15‡ | JAOA—Journal of the American Osteopathic Association (2002) | Comparison of clinical outcomes in women with fibromyalgia syndrome divided into four experimental groups. | Prospective, randomized clinical trial (N=24) found significant group receiving standard care only, improvement in daily functioning in OMT group compared with all others, but no differences among the four groups on increased feelings of well-being. No cost data reported. Cost savings could be found in restoring daily function. |
▪ Studies Using Indirect/Imputed Cost Variables | | | |
□ Hess7† | Journal of Manipulative Physiological Therapies (1999) | Comparison of responses to case vignettes using RBRVS by provider type to encourage the reduction of restrictions on E/M codes used by chiropractors. | Compares responses of chiropractors to two case vignettes of spine-related conditions to responses by osteopathic and allopathic physicians, as obtained in results of a previous survey (RBRVS). Suggests that chiropractors perform the same E/M procedures and total work intensity as physicians and that total work equals cost. No discussion of what cost implications might be. Suggests RBRVS is used in calculating Medicare fee schedules and thus has merit in comparing service choices made by provider type per specific clinical cases |
□ Klock10‡ | AAO [American Academy of Osteopathy] Journal (2002) | Examined differences in hospital length of stay between two groups to determine whether structural abnormalities may reliably predict coronary artery disease and whether OMT would reduce length of stay or risk for readmission. | Modest in rigor, this study has interesting clinical findings associated with reduced length of hospital stay. Imputed costs are associated with the ability of the physician to detect disease earlier and avoid higher future costs. |
□ Knebl16§ | JAOA—Journal of the American Osteopathic Association (2002) | Comparison of improvements in range of motion in elderly patients (OMT versus sham manipulative treatment). | Prospective, randomized study finds significant improvement in OMT group and deterioration in the control group but increases in pain in both groups at 6 weeks' posttreatment follow-up, though the rate of rise in pain scores was nearly two times greater for the control group. Cost implications are for reduced nursing and other chronic healthcare services in elderly patients. |
□ Licciardone13§ | JAOA—Journal of the American Osteopathic Association (2002) | Comparison of results between patients in an OMT clinic with general population data from a national database on pain, quality of life, and severity of physical limitations. | Descriptive study (N=185) suggests that earlier detection and treatment of musculoskeletal problems may prevent chronic disability and dependency. |
□ Licciardone14§ | JAOA—Journal of the American Osteopathic Association (2002) | Examination of the relationship between patient satisfaction and pain reduction in patients receiving OMT in an ambulatory clinic. | Survey method (N=459) for a correlation study finds most dissatisfaction reported for poor health insurance coverage for OMT and significant correlations between overall patient satisfaction levels and a decrease in pain. Study suggests insurance coverage should be extended to improve quality of healthcare. |
□ Noll12‡ | JAOA—Journal of the American Osteopathic Association (1998) | Comparison of clinical outcomes in pneumonia patients (OMT versus sham manipulative treatment). | Prospective, randomized, placebo-controlled study finds reduced use of intravenous antibiotics and reduced length of hospital stay in the OMT group. No cost data collected. |
□ Radjieski11‡ | JAOA—Journal of the American Osteopathic Association (2000) | Comparison of patients hospitalized with pancreatitis (OMT versus standard medical care). | Length of hospital stay is significantly shorter in OMT group than in study group receiving standard care, even though patients did not differ in requests for pain medication or days spent without oral intake. No cost data collected. |
□ Swords8
| AAO [American Academy of Osteopathy] Journal (2000)
| Survey to describe costs and outcomes associated with treatment for low back pain.
| No costs are reported. Survey findings described in tables.
|