Long-Term Medicare Costs Associated With Opioid Analgesic Therapy vs Spinal Manipulative Therapy for Chronic Low Back Pain in a Cohort of Older Adults.
Long-Term Medicare Costs Associated With Opioid Analgesic Therapy vs Spinal Manipulative Therapy for Chronic Low Back Pain in a Cohort of Older Adults.
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DOI：
10.1016/j.jmpt.2021.09.001
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发表时间：
2021-09
影响因子：
1.3
通讯作者：
Coulter I
中科院分区：
文献类型：
--
作者：
Whedon JM;Kizhakkeveettil A;Toler A;MacKenzie TA;Lurie JD;Bezdjian S;Haldeman S;Hurwitz E;Coulter I
本研究的目的是比较接受阿片类镇痛治疗（OAT）或脊柱推拿治疗（SMT）长期治疗慢性腰痛（cLBP）的患者的医疗保险医疗费用。我们进行了一项回顾性观察研究，采用队列设计分析医疗保险索赔数据。研究人群包括2012年至2016年参加Medicare Part A、B和D的Medicare受益人。我们收集了接受OAT或SMT（例如由脊椎指压治疗或整骨疗法从业者提供）长期管理cLBP的患者队列，并评估了OAT与SMT对支出的比较效果，使用多变量回归控制受益人特征和健康状况指标，并使用倾向评分加权和分组来解释选择偏倚。研究样本共计28，160例受试者，其中77%开始使用OAT进行cLBP长期护理，23%开始使用SMT进行护理。特别是对于腰痛的治疗，开始OAT治疗的患者的平均长期成本比开始SMT治疗的患者低58%。然而，通过OAT开始治疗的患者在Medicare下的总体长期医疗保健支出是通过SMT开始治疗的患者的1.87倍（95% CI 1.65-2.11; p <0.0001）。通过OAT开始长期治疗cLBP的65-84岁成人的腰痛长期费用较低，但与开始长期SMT治疗的患者相比，Medicare下的长期总医疗费用较高。
The purpose of this study was to compare Medicare healthcare expenditures for patients who received long-term treatment of chronic low back pain (cLBP) with either opioid analgesic therapy (OAT) or spinal manipulative therapy (SMT). We conducted a retrospective observational study using a cohort design for analysis of Medicare claims data. The study population included Medicare beneficiaries enrolled under Medicare Parts A, B, and D from 2012 through 2016. We assembled cohorts of patients who received long-term management of cLBP with OAT or SMT (such as delivered by chiropractic or osteopathic practitioners) and evaluated the comparative effect of OAT vs SMT upon expenditures, using multivariable regression to control for beneficiary characteristics and measures of health status, and propensity score weighting and binning to account for selection bias. The study sample totaled 28,160 subjects, of whom 77% initiated long-term care of cLBP with OAT, and 23% initiated care with SMT. For care of low back pain specifically, average long-term costs for patients who initiated care with OAT were 58% lower than those who initiated care with SMT. However, overall long-term healthcare expenditures under Medicare were 1.87 times higher for patients who initiated care via OAT as compared to those initiated care with SMT (95% CI 1.65-2.11; p <0.0001). Adults aged 65-84 who initiated long-term treatment for cLBP via OAT incurred lower long-term costs for low back pain, but higher long-term total healthcare costs under Medicare as compared to patients who initiated long-term treatment with SMT.
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影响因子：
3
作者：
Keeney BJ;Fulton-Kehoe D;Turner JA;Wickizer TM;Chan KC;Franklin GM
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Franklin GM
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