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Original research article
Cost-effectiveness of chiropractic care versus self-management in patients with musculoskeletal chest pain
  1. Mette Jensen Stochkendahl1,
  2. Jan Sørensen2,
  3. Werner Vach3,
  4. Henrik Wulff Christensen1,
  5. Poul Flemming Høilund-Carlsen4 and
  6. Jan Hartvigsen1,5
  1. 1Nordic Institute of Chiropractic and Clinical Biomechanics, Odense M, Denmark
  2. 2Department of Public Health, Centre for Health Economics Research (COHERE), University of Southern Denmark, Odense C, Denmark
  3. 3Center of Medical Biometry and Medical Informatics, Institute of Medical Biometri and Medical Informatics, University Medical Center Freiburg, Freiburg, Germany
  4. 4Department of Nuclear Medicine, Odense University Hospital, Odense C, Denmark
  5. 5Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense C, Denmark
  1. Correspondence to Dr Mette Jensen Stochkendahl; m.jensen{at}


Aims To assess whether primary sector healthcare in the form of chiropractic care is cost-effective compared with self-management in patients with musculoskeletal chest pain, that is, a subgroup of patients with non-specific chest pain.

Methods and results 115 adults aged 18–75 years with acute, non-specific chest pain of musculoskeletal origin were recruited from a cardiology department in Denmark. After ruling out acute coronary syndrome and receiving usual care, patients with musculoskeletal chest pain were randomised to 4 weeks of community-based chiropractic care (n=59) or to a single information session aimed at encouraging self-management as complementary to usual care (n=56). Data on resource use were obtained from Danish national registries and valued from a societal perspective. Patient cost and health-related quality-adjusted life years (QALYs; based on EuroQol five-dimension questionnaire (EQ-5D) and Short Form 36-item Health Survey (SF-36)) were compared in cost-effectiveness analyses over 12 months from baseline. Mean costs were €2183 lower for the group with chiropractic care, but not statistically significant (95% CI −4410.5 to 43.0). The incremental cost-effectiveness ratio suggested that chiropractic care was cost-effective with a probability of 97%, given a threshold value of €30 000 per QALY gained. In both groups, there was an increase in the health-related quality of life, and the mean increases were similar over the 12-month evaluation period. The mean differences in QALYs between the groups were negligible.

Conclusions Chiropractic care was more cost-effective than self-management. Therefore, chiropractic care can be seen as a good example of a targeted primary care approach for a subgroup of patients with non-specific chest pain.

Trial registration number NCT00462241.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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