Case Study

Improving Outcomes for Back Pain

Improving Outcomes for Back Pain

Can we reduce cost while improving outcomes for Back Pain patients?

Cost-effectiveness of a Multidisciplinary Back Pain Care System in a Managed Care Setting

June 30, 2015

Background Context

There has been an exponential increase in costs for spine care. Prior work has shown that isolated lumbar strengthening and integrated team approach can significantly reduce pain and reduce physical and psychological dysfunction. We studied a comprehensive treatment protocol that was intermediate between secondary and tertiary care and compared the cost effectiveness to standard treatment for back and neck pain.


We compared the cost-effectiveness of two-types of treatments to treat chronic neck and low back pain and radiculopathy in a managed care setting.

Study Design

Two-year retrospective case-control study comparing total cost of spine care between two different protocols of care.

Patient Sample

SpineZone patients and non-SpineZone patients were selected from a managed-care group in San Diego County. The control patients were matched with the ICD-9 codes. The average age of the non-SpineZone patients (NSZ) were 59.1 years (+/- 17.8 years) with 63% female and 37% male. The average age of the SpineZone (SZ) patients were 54.9 years (+/- 14.8 years) with 62% female and 38% male.

Outcome Measures

Claims data was provided for both groups of patients and included procedures-related to diagnoses relevant to the study. Cost analysis was then performed by examining the category associated costs. Pain levels were measured before and after the program in the SpineZone group on the Visual Analog Scale.


Claims data were provided for SpineZone patients and a group of control subjects over a two-year period. Both groups suffered from greater than 6 weeks of pain that was not controlled by standard treatment by the primary care physician. The SpineZone group underwent up to three months of measurement driven, targeted strengthening, postural measurement and treatment, behavioral management, and spine-specific education (including mobility and flexibility exercises). Patients were seen for initial and monthly visits with either orthopedic spine surgeon or physician assistant. The control group underwent “standard care” which consisted of physical therapy, chiropractic, pain management injections, and or spine specialist evaluation as per the discretion of the primary care physician. Comparison of the groups was performed using two-sample T-tests.


A 31% reduction of total cost per patient was noted in the SpineZone population as compared to the Non-SpineZone population with significant savings in inpatient (which includes surgery) and emergency room costs. There were higher costs in physical therapy and primary care evaluation and management in the SpineZone population. There was a savings of $953 per patient over the two-year study period. Pain levels decreased 46% from 5.4 to 2.9 in the SZ group.


A treatment protocol incorporating targeted strengthening within a multidisciplinary system with routine evaluation and follow-up by orthopedic spine surgeon or physician assistant can significantly decrease the overall cost of spinal care in a managed care population.

Medical expenditure; spine expenditures; back pain; neck pain; utilization; health services; outcomes.