This study demonstrated that an IPUPT model was associated with a twofold lower incidence of spine-related inpatient claims when compared to SPT, and was comparable to the NoPT group. Similarly, for outpatient care utilization, the IPUPT group had half of the number of patients utilizing outpatient care compared to the NoPT group, and the SPT group had the greatest number of claims/person per year. Outpatient utilization was primarily driven by radiology costs, followed by laboratory services which were both highest in the NoPT group. Total cost of care per year was over $20 million with the greatest average cost per person in the SPT group at $2,243.66 per person/year. The IPUPT group had the lowest cost of care per person/year at $1,259.88. Outpatient costs represented more than 60% of the total cost of care across the duration of the study period. Membership in the IPUPT group resulted in a total cost saving of approximately $878 per person/year compared to the SPT group, and $16 per person/year compared to the NoPT group, suggesting that not only is the utilization of an interdisciplinary program associated with reduced inpatient and outpatient service utilization, it also reduces overall cost of care over the duration of a 1 year period.

These data are consistent with some prior literature suggesting that initiating physical therapy as a first point of care can reduce costs^5,9. In this literature, these cost reductions were primarily attributed to reductions in outpatient procedures such as injections and radiology in individuals with acute LBP, which is similar to our findings on the primary drivers of outpatient cost. Another recent study demonstrated small but significant cost savings with clinically significant improvements in disability over a 1-year duration in individuals with acute and subacute back or neck pain who underwent a biopsychosocially informed multidisciplinary intervention as compared to a posturally focused physical therapy intervention or standard conservative care¹⁷. A recent economic evaluation prepared for the Alliance for Physical Therapy Quality and Innovation reported an overall cost savings of $4,160 with utilization of physical therapy in individuals with acute low back pain as compared to usual care²².

Interestingly, although the majority of cost savings with physical therapy have been demonstrated to be in the setting of acute low back pain, the clinical practice guidelines most heavily emphasize physical therapy as a modality to be used for individuals with chronic spine pain, and often omit physical therapy as a recommendation in the acute phase due to the thought that it is primarily self-limiting in the first 90 days¹⁰. Although our dataset did not include information on chronicity across groups, it is possible that the NoPT group may be biased toward individuals with more acute symptoms, who were not deemed to require a physical therapy referral.

In contrast to the aforementioned evidence supporting cost-effectiveness of physical therapy, two small clinical trials demonstrated no difference in cost-effectiveness of physical therapy as compared to general practitioner’s care alone in individuals with sciatica²³, and individuals with neck pain²⁴. Other trials have found either no difference, or higher total costs in protocols with multidisciplinary protocols, including various combinations of exercise therapy, education, graded activity and behavioral principles as compared to physical therapy in individuals with chronic low back pain^25,26. However, although more rigorously controlled randomized controlled trials may be useful in evaluating the value of clinical improvements across groups, it may not be representative of actual practice on a larger scale, where individuals often self-select or are directed into care categories by a prescribing primary care provider, and variability in provider and region plays a role in care pathways and cost patterns.