The use of complementary and integrative health approaches for chronic musculoskeletal pain in younger US Veterans: An economic evaluation.
Author: Herman PM1, Yuan AH2, Cefalu MS1, Chu K2, Zeng Q3,4, Marshall N5, Lorenz KA5,6, Taylor SL2,7
Affiliation:
1RAND Corporation, Santa Monica, California, United States of America.
2Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, United States of America.
3Center for Health and Aging, VA Washington DC Healthcare System, Washington, District of Columbia, United States of America.
4Biomedical Informatics Center, George Washington University, Washington, District of Columbia, United States of America.
5Center for the Study of Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, California, United States of America.
6Stanford Medical School, Palo Alto, California, United States of America.
7Department of Health Policy and Management, UCLA School of Public Health, Los Angeles, California, United States of America.
Conference/Journal: PLoS One.
Date published: 2019 Jun 5
Other:
Volume ID: 14 , Issue ID: 6 , Pages: e0217831 , Special Notes: doi: 10.1371/journal.pone.0217831. eCollection 2019. , Word Count: 248
OBJECTIVES: To estimate the cost-effectiveness to the US Veterans Health Administration (VA) of the use of complementary and integrative health (CIH) approaches by younger Veterans with chronic musculoskeletal disorder (MSD) pain.
PERSPECTIVE: VA healthcare system.
METHODS: We used a propensity score-adjusted hierarchical linear modeling (HLM), and 2010-2013 VA administrative data to estimate differences in VA healthcare costs, pain intensity (0-10 numerical rating scale), and opioid use between CIH users and nonusers. We identified CIH use in Veterans' medical records through Current Procedural Terminology, VA workload tracking, and provider-type codes.
RESULTS: We identified 30,634 younger Veterans with chronic MSD pain as using CIH and 195,424 with no CIH use. CIH users differed from nonusers across all baseline covariates except the Charlson comorbidity index. They also differed on annual pre-CIH-start healthcare costs ($10,729 versus $5,818), pain (4.33 versus 3.76), and opioid use (66.6% versus 54.0%). The HLM results indicated lower annual healthcare costs (-$637; 95% CI: -$1,023, -$247), lower pain (-0.34; -0.40, -0.27), and slightly higher (less than a percentage point) opioid use (0.8; 0.6, 0.9) for CIH users in the year after CIH start. Sensitivity analyses indicated similar results for three most-used CIH approaches (acupuncture, chiropractic care, and massage), but higher costs for those with eight or more CIH visits.
CONCLUSIONS: On average CIH use appears associated with lower healthcare costs and pain and slightly higher opioid use in this population of younger Veterans with chronic musculoskeletal pain. Given the VA's growing interest in the use of CIH, further, more detailed analyses of its impacts are warranted.
PMID: 31167005 DOI: 10.1371/journal.pone.0217831
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