Acupuncture Versus Analgesic Pharmacotherapy: Comparison of Efficiency in the Management of Low Back Pain Among Medicare Fee-for-Service Beneficiaries
James M. Whedon, Leah Grout, Todd A. MacKenzie, S. Prasad Vinjamury, Louis A. KazalStudy Design:
Retrospective cohort design
Objective:
The purpose of this study was to compare initial care with acupuncture
Summary of Background Data:
Usual medical care for chronic low back pain (cLBP) tends to be inefficient because health care resources are often overutilized, unnecessarily escalating the course of care. In 2020, Medicare initiated coverage of acupuncture for treatment of cLBP. The efficiency of acupuncture for the management of cLBP among Medicare beneficiaries is unknown.
Methods:
We examined Medicare claims data for 2020-2023. We compared rates of escalation of care between two cohorts of patients seen for cLBP, assembled according to initial treatment. The ACU cohort received acupuncture; the MED cohort saw a primary care physician and filled a prescription for analgesic medication from the same physician within 7 days, with no acupuncture. We measured rates of secondary care encounters indicative of escalation of care at 6 months. We modeled the odds of care escalations for ACU
Results:
For any escalation, risk was higher for ACU
Conclusions:
The comparative risk of escalation of care favored acupuncture over pharmacotherapy for emergency department visits, imaging, and use of opioid analgesics. The acupuncture group had higher rates of medical specialist encounters and of interventional pain management among chronic cases.
Level of evidence:
Level III.