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Table 1

Return to:   A Systematic Review Comparing the Costs of Chiropractic Care
to other Interventions for Spine Pain in the United States

Study design for cost comparisons in private health plans

First authorYearLocation/Plan typeData type/SourceData start -Data endEligibilityIndication/Duration# ICD-9 codesInclusionExclusion# Insured/# Eligible/# Included
Allen [33]2014National/Self-insured employerClaims/Navistar integrated databasee 1/1/2001 - 12/31/2009Back pain diagnosisLow back pain/Any771. Back pain episodes identified by one or more of 77 ICD-9 codes 2. 6 months of recorded continuous coverageCancer diagnosis, retired, died during study periodNR/21,080/14,787d
Grieves [29]2009Wisconsin/HMOClaims/Arise Health Plan1/1/2004 - 12/31/20051. Continuously enrolled, and 2. Claim for visit to MD or DC for 12 ICD-9 codesLow back pain/Any121. Continuously enrolled; 2. Any claim for visit to MD or DCSaw both MD and DC30,000/NR/897
Liliedahl [32]2010Tennessee/NRClaims/BlueCross BlueShield10/1/2004 - 9/30/20061. Claim for 82 ICD-9 codes related to spine pain, and 2. CPT code for visit to MD, DO, ED, or DCSpine pain/Any82CPT code for visit to MD, DO, ED, or DCEpisodes not related to MD, DO, ED, or DC, or with incomplete claims records669,320/85,402/102,438d
Mosley [30]1996Louisiana/HMOClaims/Community Health Network of Louisiana10/1/1994 - 10/1/1995Claim for ICD-9 codes 720.0 to 724.9 (potentially 68 different ICD-9 codes) related to back or neck painBack or neck pain/Any68Claims related to ICD-9 codesNRNR/1,959/1,959
Shekelle [31]1995National/Fee for serviceClaims/RAND Health Insurance ExperimentNR (mean 3.6 months)b Claim related to pain, swelling, or injury of back regionPain, swelling, or injury of back/AnyNAAny back-related claim as 1/2/3 symptom1.Elderly; 2.Care paid by workers’ compensation7,706/686/1,020d
Smith [27]1997National/Fee for serviceClaims/MEDSTAT7/1/1988 - 6/30/199010 % sample of claims for 493 ICD-9 codes related to MSK conditions or claims for chiropractic careLow back conditions/Any910 % sample with claim related to ICD-9 codesUnknown first-contact provider type2,000,000a/434,763/890
Stano [28]1996National/Fee for serviceClaims/MEDSTAT7/1/1988 - 6/30/199010 % sample of claims for 493 ICD-9 codes related to MSK conditions or claims for chiropractic careLow back conditions/Any910 % sample with claim related to ICD-9 codes1. Unknown first-contact provider type; 2. Negative value claims2,000,000a/434,763/6,183
Stano [23]1995National/Fee for serviceClaims/MEDSTAT7/1/1988 - 6/30/199010 % sample of claims for 493 ICD-9 codes related to MSK conditionsLow back conditions/Any910 % sample with claim related to ICD-9 codesNegativepaymentsNR/434,763/6,799
Stano [24]1994National/Fee for serviceClaims/MEDSTAT7/1/1988 - 6/30/1990Claim for 493 ICD-9 codes related to MSK conditionsLow back conditions/Any15Claim related to ICD-9 codes1. Coinsurance >15 %; 2. Deductibles > $200; 3. No restrictions on chiropractic or medical careNR/395,641/42,331
Stano [22]1993National/Fee for serviceClaims/MEDSTAT7/1/1988 - 6/30/1990Claim for 493 ICD-9 codes related to MSK conditionsLow back conditions/Any15Claim related to ICD-9 codes1. Did not meet deductibles; 2. Did not file claims; 3. Out-of-plan use; 4. Age >652,000,000a/395,641/99,675
Stano [25]1993National/Fee for serviceClaims/MEDSTAT7/1/1988 - 6/30/1990Claim for 493 ICD-9 codes related to MSK conditionsLow back conditions/Any910 % sample with claim related to ICD-9 codesNR2,000,000a/396,000a/7,880
Stano [26]1993National/Fee for serviceClaims/MEDSTAT7/1/1988 - 6/30/19901. Claim for 493 ICD-9 codes related to MSK conditions, or 2. Claim for chiropractic careLow back conditions/Any4Claim related to ICD-9 codes1. Did not meet deductibles; 2. Did not file claims; 3. Out-of-plan use; 4. Elderly2,000,000a/396,000a/10,945
anumber reported as estimated

bas reported in separate study, 70 % participated for 36 months and 30 % participated for 60 months [64]

cinsured n and eligible n reported only for studies based on claims. Insured n refers to size of insured population. Eligible n refers to size of insured population meeting stated eligibility criteria

drefers to the number of episodes of spine pain (i.e. members could have multiple episodes)

eas reported in separate study [65]

CPT current procedural terminology, DC doctor of chiropractic, DO doctor of osteopathy, ED emergency department, HMO health maintenance organization, ICD International Classification of Diseases, LBP low back pain, MD medical doctor, MSK musculoskeletal, NA not applicable, NR not reported, RAND Research and Development Corporation