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J Pain. 2019 May 6. pii: S1526-5900(19)30001-X. doi: 10.1016/j.jpain.2019.05.002. [Epub ahead of print]

Patient willingness to pay (WTP) for reductions in chronic low back pain and chronic neck pain.

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RAND Health, RAND Corporation, Santa Monica, CA. Electronic address:
RAND Health, RAND Corporation, Santa Monica, CA.
RAND Health, RAND Corporation, Pittsburgh, PA.


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=1583) 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 to 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-i.e., they value maintenance of their current mild pain levels. These results provide some evidence for co-pay levels and their relationship to patient demand but call into question ongoing coverage policies that require documentation of continued improvement or of experienced clinical deterioration with treatment withdrawal. Perspective: This study provides estimates of reported willingness-to-pay 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.


chiropractic care; chronic low-back pain; chronic neck pain; willingness-to-pay

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