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The use of complementary and integrative health approaches for chronic musculoskeletal pain in younger US Veterans: An economic evaluation

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  • Patricia M Herman
  • Anita H Yuan
  • Matthew S Cefalu
  • Karen Chu
  • Qing Zeng
  • Nell Marshall
  • Karl A Lorenz
  • Stephanie L Taylor

Abstract

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.

Suggested Citation

  • Patricia M Herman & Anita H Yuan & Matthew S Cefalu & Karen Chu & Qing Zeng & Nell Marshall & Karl A Lorenz & Stephanie L Taylor, 2019. "The use of complementary and integrative health approaches for chronic musculoskeletal pain in younger US Veterans: An economic evaluation," PLOS ONE, Public Library of Science, vol. 14(6), pages 1-16, June.
    • Handle: RePEc:plo:pone00:0217831
    DOI: 10.1371/journal.pone.0217831
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    References listed on IDEAS

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    1. Kosuke Imai & Marc Ratkovic, 2014. "Covariate balancing propensity score," Journal of the Royal Statistical Society Series B, Royal Statistical Society, vol. 76(1), pages 243-263, January.
    2. Opher Caspi & Mary Koithan & Michael W. Criddle, 2004. "Alternative Medicine or “Alternative†Patients: A Qualitative Study of Patient-Oriented Decision-Making Processes with Respect to Complementary and Alternative Medicine," Medical Decision Making, , vol. 24(1), pages 64-79, January.
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