Comparison of management costs of low back pain according to pattern of care: The North Carolina State Health Plan for Teachers and State Employees, 2000-2009

The purpose of this paper is to compare and contrast the management costs of uncomplicated and complicated low back pain according to pattern of care. The study includes the claims for 664,000 covered lives in North Carolina over 10 years from 2000 to 2009. For uncomplicated low back pain (ULBP), 2,075,866 claims met the inclusion criteria; for complicated low back pain (CLBP), 1,083,496 claims met the inclusion criteria. Fifteen care patterns involving doctors of chiropractic (DCs), medical doctors (MDs), and physical therapists (PTs) were identified. We computed medical, pharmaceutical, and overall charges according to pattern of care, by patient and claim separately for each year in order to detect trends over time in use and costs. Utilization increased for all care patterns over the decade; however, utilization increased most dramatically for care involving MDs, PTs, and referral providers. Mean and median per-patient and per-claim charges associated with both ULBP and CLBP varied significantly by pattern of care during the 2000-2009 decade. In general, patterns of care involving multiple providers and referrals incurred the largest charges, while patterns of care involving single or non-referral providers incurred the least charges. Over the decade, average total allowed charges increased by 45% for ULBP and by 38% for complicated low back pain. For ULBP in 2009, care involving MDs was on average $849.35 (or 62.3%) more expensive than care with DCs. For CLBP in 2009, care involving MDs was on average $3163.30 (or 181.2%) more expensive than care involving DCs.