Comparison of management costs of headache according to pattern of care: The North Carolina state health plan for teachers and state employees, 2000-2009

Objective: The purpose of this paper is to compare and contrast the management costs of headache according to pattern of care.

Methods: The study includes the claims for 664,000 covered lives in North Carolina from 2000 to 2009.  Numbers of patients with headache claims ranged from 9421 in 2000 to 22,527 in 2009; overall, 910,778 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, prescription drug, and overall charges according to pattern of care (DC only, MD only, MD-DC, MD-PT, etc.), by patient and claim, by year.

Results: Over the decade, total allowed charges more than tripled and average total allowed charges per patient increased by 28%.  Per-patient and per-claim charges 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 care patterns involving single or non-referral providers incurred the least charges.  MD-only care, DC-only care, and MD-DC care were consistently the three least expensive patterns of care.  Risk-adjusted mean charges were lowest in the DC-only pattern.  Although the total allowed per patient charges were on average lower for care patterns involving MDs than DCs, total allowed charges of medical care with referrals were appreciably higher on average than total allowed charges of chiropractic care with referrals.

Conclusion: Cost comparisons of medical and chiropractic care for headache must take into account referral care, which adds significantly to overall costs.