New Neck Pain Study Suggests Timing of Imaging Impacts Costs

Sarasota, FL (WorkersCompensation.com) – Neck pain can be driven by a several causes, ranging from trauma to disc herniation, requiring an extensive exam to determine the cause. In cases where the patient may have alarming symptoms, such as fever, worsening neurological issues, the pathway is usually urgent diagnostics with the hope of a quick treatment and internvetion. For patients with new neck or upper extremity pain without urgent symptoms, the treatment path is not always so clearly defined.

Conservative treatment for new-onset neck pain usually includes physical therapy, nonsteroidal anti-inflammatory medications, steroid injections, traction or bracing, and pain management usually in the form of opioids. Commonly, if the pain has not resolved after 6 to 12 weeks, the patient may be scheduled for an MRI, but that decision may be a costly one.

According to one 2016 study, healthcare spending for low back and neck pain was $87.6 billion in 2013, equating to an overall increase of $57.2 billion since 1996. In fact, neck pain was included in one of the highest increases in spending during that time period.

Researchers from the Neurosurgery department at Standford University asked the question of how newly diagnosed acute neck pain was being managed and how those methods were associated with care delivery and costs. Using 2007 to 2016 data from the IBM Watson Health MarketScan claims database, researchers reviewed 1-year post diagnosis costs that also included opioid use and service utilization.

Complications such as traumatic cervical disc dislocations, vertebral fractures, and cancer were excluded. Only patients with at least 1 year of claims data prior to diagnosis were included. Data on a  total of 679,030 patients was reviewed, of which 1.2 percent had undergone surgery within a year of diagnosis. Researchers noted that surgical patients were generally older, frequently male, and had more comorbidities. The average age of patients that had not undergone surgery was 44.62, and the average age of the surgical set was 49.6.

For those patients that had not undergone surgery, 27.3 percent had undergone physical therapy, 22.3 percent had received chiropractic care, and 1.7 percent had received epidural steroid injections. Among the surgery group, 40.1 percent received physical therapy, 7.1 percent received chiropractic care, and 20.4 percent had received steroid injections. Twenty-three percent of non-surgical, and 18.9 percent of surgical patients pursued early physical therapy. Only .61 percent of non-surgical and 8.3 percent of surgical patients received an injection within the first month.

For the non-surgery group, 41.9 percent underwent imaging within 30 days of index diagnosis. Of those, 28.1 percent underwent radiography, 10.6 percent underwent advanced imaging, and 3.3 percent underwent both types of imaging. Among the patients that received no treatment, 46.2 percent underwent early imaging, of which 29.4 percent underwent radiography and 13.8 percent underwent advanced imaging. Three percent of the imaging group underwent both types of imaging.

The total spent on the non-surgical group total $346,069,711, averaging out $515.62 per patient. For the surgical group, the total paid was $189,826,915, averaging out to $24,157.15 per patient. Allowing for demographics and comorbidities, the 1-year regression-adjusted health care cost for surgical patients was estimated at $24,267.55, and $515.69 for non-surgical patients. Half of the surgical patients and 89.4 percent of the non-surgical patients incurred no costs at the 6 to 12 month mark.

For costs, among the non-surgical group, imaging accounted for 26 percent, physical therapy accounted for 24.2 percent, chiropractic accounted for 11.7 percent, and injections totaled 3.8 percent. For those patients that did not receive treatment, imaging constituted 36.6 percent of their total costs. Of those patients that received early imaging, the total costs was $95,379,949, averaging out to $477.53 per patient, with costs ranging $20.70 to $452.37 per patient. This accounted for 27.6 percent of the non-surgical costs and $17.8 percent of the total costs.

The researchers noted that early use of imaging was associated with significantly higher weekly costs. Early opioid use was also associated with higher weekly long-term healthcare costs. User of conservative therapy such as physical or chiropractic was associated with significantly decreased weekly health care costs to the tune of 35 to 60 percent of average costs of patients that did not do therapy. After adjustment, conservative therapy was associated with a 24.8 percent lower long-term health cost.

The researchers noted that injections were used more often in non-surgical patients that received early imaging as opposed to early conservative therapy. Additionally, injection use was lowest among patients that underwent early physical therapy, had no opioid use, and underwent no early imaging. In regards to time period, the average time to injection for those in therapy was 131.4 days, compared to 74.2 days for those that underwent imaging only, and 72.7 for those that received therapy and imaging.

A total of 72,194 patients, 10.6 percent, received opioids within the first month of diagnosis. Additionally, 10.3 percent of the non-surgical group required opioids. Long-term opioid abstinence was most common among the non-surgical group that received only conservative therapy. Those patients that received early conservative therapy had a later start use date of 157.4 days compared to 95.1 days for those undergoing early imaging, and 128.9 days for those patients that underwent both.

The researchers estimated that patients with acute neck pain that underwent early imaging but no further treatment contributed more than $100 million annual to health care costs. Additionally, they surmised that early conservative treatment was associated with reduced long term costs as well as opioid use. Overall, the researchers believe the sequence and long term patterns of care alter the efficiency of health care delivery and costs.

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