Advertisement

Patient Willingness to Pay for Reductions in Chronic Low Back Pain and Chronic Neck Pain

      Highlights

      • Willingness to pay for a 1-point reduction in chronic back pain was $45.98 per month.
      • Willingness to pay for a 1-point reduction in chronic neck pain was $37.32 per month.
      • These estimates met a variety of validity checks including downward-sloping demand.
      • Patients reported that their pain would be higher without chiropractic visits.
      • Comparing stated WTP with visit costs indicates patients pay to avoid this higher pain.

      Abstract

      Many recommended nonpharmacologic therapies for patients with chronic spinal pain require visits to providers such as acupuncturists and chiropractors. Little information is available to inform third-party payers’ coverage policies regarding ongoing use of these therapies. This study offers contingent valuation-based estimates of patient willingness to pay (WTP) for pain reductions from a large (n = 1,583) sample of patients using ongoing chiropractic care to manage their chronic low back and neck pain. Average WTP estimates were $45.98 (45.8) per month per 1-point reduction in current pain for chronic low back pain and $37.32 (38.0) for chronic neck pain. These estimates met a variety of validity checks including that individuals’ values define a downward-sloping demand curve for these services. Comparing these WTP estimates with patients’ actual use of chiropractic care over the next 3 months indicates that these patients are likely “buying” perceived pain reductions from what they believe their pain would have been if they didn't see their chiropractor—that is, they value maintenance of their current mild pain levels. These results provide some evidence for copay levels and their relationship to patient demand, but call into question ongoing coverage policies that require the documentation of continued improvement or of experienced clinical deterioration with treatment withdrawal.

      Perspective

      This study provides estimates of reported WTP for pain reduction from a large sample of patients using chiropractic care to manage their chronic spinal pain and compares these estimates to what these patients do for care over the next 3 months, to inform coverage policies for ongoing care.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Pain
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Amtmann D
        • Kim J
        • Chung H
        • Bamer AM
        • Askew RL
        • Wu S
        • Cook KF
        • Johnson KL
        Comparing CESD-10, PHQ-9, and PROMIS depression instruments in individuals with multiple sclerosis.
        Rehabil Psychol. 2014; 59: 220
        • Balistreri E
        • McClelland G
        • Poe G
        • Schulze W
        Can hypothetical questions reveal true values? A laboratory comparison of dichotomous choice and open-ended contingent values with auction values.
        Environ Resource Econ. 2001; 18: 275-292
        • Bijur PE
        • Latimer CT
        • Gallagher EJ
        Validation of a verbally administered numerical rating scale of acute pain for use in the emergency department.
        Acad Emerg Med. 2003; 10: 390-392
        • California Division of Workers' Compensation
        Medical Treatment Utilization Schedule (MTUS) Chronic Pain Medical Treatment Guidelines, State of California, Sacramento, CA.
        California Department of Industrial Relations, Sacramento, CA2016
        • Canadian Chiropractic Association and Canadian Federation of Chiropractic Regulatory Boards Clinical Practice Guidelines Development Initiative Guidelines Development Committee
        Chiropractic clinical practice guideline: Evidence-based treatment of adult neck pain not due to whiplash.
        J Can Chiropract Assoc. 2005; 49: 158
        • Childs JD
        • Piva SR
        • Fritz JM
        Responsiveness of the numeric pain rating scale in patients with low back pain.
        Spine. 2005; 30: 1331
        • Chou R
        • Deyo R
        • Friedly J
        • Skelly A
        • Hashimoto R
        • Weimer M
        • Fu R
        • Dana T
        • Kraegel P
        • Griffin J
        Nonpharmacologic therapies for low back pain: A systematic review for an American College of Physicians Clinical Practice Guideline.
        Ann Intern Med. 2017; 166: 493-505
        • Chuck A
        • Adamowicz W
        • Jacobs P
        • Ohinmaa A
        • Dick B
        • Rashiq S
        The willingness to pay for reducing pain and pain‐related disability.
        Value Health. 2009; 12: 498-506
        • Cleland JA
        • Fritz JM
        • Whitman JM
        • Palmer JA
        The reliability and construct validity of the Neck Disability Index and patient specific functional scale in patients with cervical radiculopathy.
        Spine. 2006; 31: 598-602
        • Colorado Division of Workers' Compensation
        Cervical spine injury medical treatment guidelines.
        Colorado Division of Workers' Compensation, Denver, CO2014: 96
        • Colorado Division of Workers' Compensation
        Low back pain medical treatment guidelines.
        Colorado Division of Workers' Compensation, Denver, CO2014: 112
        • Cooper RA
        • McKee HJ
        Chiropractic in the United States: Trends and issues.
        Milbank Q. 2003; 81: 107-138
        • Coulter ID
        • Herman PM
        • Ryan GW
        • Hays RD
        • Hilton LG
        • Whitley MD
        Researching the appropriateness of care in the complementary and integrative health (CIH) professions: Part 1.
        J Manipulative Physiol Ther. 2019; 41: 800-806
        • Coulter ID
        • Herman PM
        • Ryan GW
        • Hays RD
        • Hilton LJ
        • CERC Team
        The challenge of determining appropriate care in the era of patient-centered care and rising health care costs.
        J Health Serv Res Policy. 2019; 24 (doi:10.1177/1355819618815521): 201-206
        • Coulter ID
        • Shekelle PG
        Chiropractic in North America: A descriptive analysis.
        J Manip Physiol Ther. 2005; 28: 83-89
        • Danyliv A
        • Pavlova M
        • Gryga I
        • Groot W
        Willingness to pay for physician services: Comparing estimates from a discrete choice experiment and contingent valuation.
        Society and Economy. 2012; 34: 339-357
        • Davidson M
        • Keating JL
        A comparison of five low back disability questionnaires: Reliability and responsiveness.
        Phys Ther. 2002; 82: 8-24
        • Downie W
        • Leatham P
        • Rhind V
        • Wright V
        • Branco J
        • Anderson J
        Studies with pain rating scales.
        Ann Rheum Dis. 1978; 37: 378-381
        • Drummond MF
        • Sculpher MJ
        • Torrance GW
        • O'Brien BJ
        • Stoddart GL
        Methods for the Economic Evaluation of Health Care Programmes.
        3rd ed. Oxford University Press, Oxford, UK2005
        • Fairbank J
        • Couper J
        • Davies J
        • O'brien J
        The Oswestry low back pain disability questionnaire.
        Physiotherapy. 1980; 66: 271-273
        • Farabaugh RJ
        • Dehen MD
        • Hawk C
        Management of chronic spine-related conditions: Consensus recommendations of a multidisciplinary panel.
        J Manipulative Physiol Ther. 2010; 33: 484-492
        • Fisher K
        • Johnston M
        Validation of the Oswestry low back pain disability questionnaire, its sensitivity as a measure of change following treatment and its relationship with other aspects of the chronic pain experience.
        Physiother Theory Pract. 1997; 13: 67-80
        • Globe G
        • Farabaugh RJ
        • Hawk C
        • Morris CE
        • Baker G
        • Whalen WM
        • Walters S
        • Kaeser M
        • Dehen M
        • Augat T
        Clinical practice guideline: Chiropractic care for low back pain.
        J Manipulative Physiol Ther. 2016; 39: 1-22
        • Globe GA
        • Morris CE
        • Whalen WM
        • Farabaugh RJ
        • Hawk C
        Chiropractic management of low back disorders: Report from a consensus process.
        J Manipulative Physiol Ther. 2008; 31: 651-658
        • Grönblad M
        • Hupli M
        • Wennerstrand P
        • Järvinen E
        • Lukinmaa A
        • Kouri J-P
        • Karaharju EO
        Inter-correlation and test-retest reliability of the pain disability index (PDI) and the Oswestry disability questionnaire (ODQ) and their correlation with pain intensity in low back pain patients.
        Clin J Pain. 1993; 9: 189-195
        • Herman PM
        • Kommareddi M
        • Sorbero ME
        • Rutter CM
        • Hays RD
        • Hilton LG
        • Ryan GW
        • Coulter ID
        Characteristics of chiropractic patients being treated for chronic low back and chronic neck pain.
        J Manipulative Physiol Ther. 2018; 41: 445-455
        • Heyward J
        • Jones CM
        • Compton WM
        • Lin DH
        • Losby JL
        • Murimi IB
        • Baldwin GT
        • Ballreich JM
        • Thomas DA
        • Bicket MC
        Coverage of nonpharmacologic treatments for low back pain among US public and private insurers.
        JAMA Network Open. 2018; 1 (-e183044)e183044
        • Hurwitz EL
        Epidemiology: Spinal manipulation utilization.
        J Electromyography Kinesiol. 2012; 22: 648-654
        • Huskisson E
        Measurement of pain.
        Lancet. 1974; 304: 1127-1131
        • Institute of Medicine
        Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research.
        The National Academies Press, Washington, DC2011
        • Johannes CB
        • Le TK
        • Zhou X
        • Johnston JA
        • Dworkin RH
        The prevalence of chronic pain in United States adults: Results of an Internet-based survey.
        J Pain. 2010; 11: 1230-1239
        • Martin BI
        • Deyo RA
        • Mirza SK
        • Turner JA
        • Comstock BA
        • Hollingworth W
        • Sullivan SD
        Expenditures and health status among adults with back and neck problems.
        JAMA. 2008; 299: 656-664
        • Martin BI
        • Gerkovich MM
        • Deyo RA
        • Sherman KJ
        • Cherkin DC
        • Lind BK
        • Goertz CM
        • Lafferty WE
        The association of complementary and alternative medicine use and health care expenditures for back and neck problems.
        Med Care. 2012; 50: 1029-1036
        • McCarthy MJH
        • Grevitt M
        • Silcocks P
        • Hobbs G
        The reliability of the Vernon and Mior neck disability index, and its validity compared with the short form-36 health survey questionnaire.
        Eur Spine J. 2007; 16: 2111-2117
        • Olsen JA
        • Smith RD
        Theory versus practice: A review of 'willingness-to-pay' in health and health care.
        Health Econ. 2001; 10: 39-52
        • Paice JA
        • Cohen FL
        Validity of a verbally administered numeric rating scale to measure cancer pain intensity.
        Cancer Nurs. 1997; 20: 88-93
        • Posner J
        • Glew C
        Neck Pain.
        Ann Intern Med. 2002; 136: 758-759
        • Qaseem A
        • Wilt TJ
        • McLean RM
        • Forciea MA
        Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians.
        Ann Intern Med. 2017; 166: 514-530
        • R Core Team
        R: A language and environment for statistical computing.
        R Foundation for Statistical Computing, Vienna, Austria2018
        • Salaffi F
        • Stancati A
        • Silvestri CA
        • Ciapetti A
        • Grassi W
        Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale.
        Eur J Pain. 2004; 8: 283-291
        • Smith RD
        The discrete-choice willingness-to-pay question format in health economics: Should we adopt environmental guidelines?.
        Med Decis Making. 2000; 20: 194-206
        • Smith RD
        Construction of the contingent valuation market in health care: A critical assessment.
        Health Econ. 2003; 12: 609-628
        • Stewart WF
        • Ricci JA
        • Chee E
        • Morganstein D
        • Lipton R
        Lost productive time and cost due to common pain conditions in the US Workforce.
        JAMA. 2003; 290: 2443-2454
        • The Diagnosis and Treatment of Low Back Pain Work Group
        VA/DoD Clinical Practice Guideline for Diagnosis and Treatment of Low Back Pain, Version 2.0, The Office of Quality, Safety and Value, VA, & Office of Evidence Based Practice.
        U.S. Army Medical Command, Washington, DC2017
        • The Joint Commission
        Non-pharmacologic and non-opioid solutions for pain management.
        Quick Safety. 2018; (August:1-2)
        • Vernon H
        The Neck Disability Index: State-of-the-art, 1991-2008.
        J Manipulative Physiol Ther. 2008; 31: 491-502
        • Vernon H
        • Mior S
        The Neck Disability Index: A study of reliability and validity.
        J Manipulative Physiol Ther. 1991; 14: 409
        • Wheeler AH
        • Goolkasian P
        • Baird AC
        • Darden BV
        Development of the Neck Pain and Disability Scale: Item analysis, face, and criterion-related validity.
        Spine. 1999; 24: 1290