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Associations Between Complementary and Alternative Medicine and Health Care Expenditures Among Adults With Chronic Back Pain

Background: Although complementary and alternative medicine (CAM) has been associated with reduced morbidity among adults with chronic back pain, less is known about the association between CAM use and health care expenditures. Objectives: The objective of this study was to first estimate health care expenditures of adult CAM users and nonusers with chronic back pain and then assess CAM’s influence on health care expenditures. Research Design: This was an ambidirectional cohort study. Data: Linked National Health Interview Survey (2012) and Medical Expenditure Panel Survey (2013–2014). Measures: CAM use was defined as 3 or more visits to a practitioner in the 12 months before the National Health Interview Survey interview. Covariates included age, sex, race-ethnicity, and body mass index. The outcome was annual health care expenditures (overall and within 8 categories, including office-based visits and prescription medication). Analyses: Survey-weighted, covariate adjusted predicted marginal means models were applied to quantify health care expenditures. Survey-weighted, covariate adjusted linear and logistic regression models were used to investigate CAM’s influence on expenditures, and the Z mediation test statistic was applied to quantify the independent effects of CAM. Results: Overall, health care expenditures were significantly lower among CAM users with chronic back pain compared with non-CAM users for both 2013 and 2014: $8402 versus $9851 for 2013; $7748 versus $10,227 in 2014, annual differences of −$1499 (95% confidence interval: −$1701 to −$1197) and −$2479 (95% confidence interval: −$2696 to −$2262), respectively (P<0.001). Adult CAM users also had significantly lower prescription medication as well as outpatient expenses (P<0.001). CAM use was identified as a partial mediator to health care expenditures. Conclusion: CAM use is associated with lower overall health care expenditures, driven primarily by lower prescription and outpatient expenditures, among adults with chronic back pain in the United States.