Written by Dr. Sean Heerey.* This is the fourth article of a six-article series on the efficacy, cost-effectiveness, and safety of naturopathic medicine when it comes to health promotion and disease prevention based on research from across the country. To read the first three articles of The Value of Naturopathic Medicine in New York, please click here: The Problem: Chronic Disease, Evidence-Based Chronic Disease Prevention, and Training.

Naturopathic medicine is a medical system defined by its philosophy of treating the “cause of disease” and not just alleviating symptoms. It includes health promotion, disease prevention and health care education for patient empowerment. Some of the tools Naturopathic Doctors (NDs) utilize include lab testing (especially looking for unhealthy trends to intervene early), dietary modifications, nutrients, herbal therapies, supplements and lifestyle changes to support patients with health.

U.S. Senate Resolution 221 of the 113th Congress states that “naturopathic doctors are skilled in preventing and treating chronic disease; that naturopathic medicine is a safe, effective, and affordable means of health care; and that licensure of naturopathic doctors helps address the shortage of primary care physicians in the United States, while also providing people with more choice in health care.”

Part IV

COST EFFECTIVENESS

Naturopathic Medicine Reduces Chronic Risk Factors and Saves Significant Healthcare Costs

848 employees for the Vermont Automobile Dealers Association were examined and advised by Naturopathic Doctors (NDs) for one year. The organization saved $1.5 million in direct and indirect medical costs the first year; that is $1800 per employee.

The drastic reduction in health risk factors has resulted in a decrease in insurance premiums for each year the program has been in place.

Direct health care costs were reduced by an estimated $315,817 leading to a 4.6 to 1 return on investment
Indirect health care costs were reduced by an estimated $1,143,657 leading to a 16.5 to 1 return on investment
Combined direct and indirect health care savings lead to overall 21.1 to 1 return on investment ($21.10 saved for every dollar invested)
Only 0.2% increase in per member claims cost (2005) compared to a national average of over 7%.

When chronic disease risk factors are reduced, savings results and quality of life

36% reduction in the incidence of hypertension
16% reduction in the incidence of high cholesterol
35% reduction in multiple cardiovascular risks
17% reduction in smokers
21% reduction of physically inactive employees
25% reduction of excessive stress (both work and personal)

SOURCE: Vermont Automobile Dealer’s Association and Green Mountain Wellness Solutions

Studies from Washington State show naturopathic medicine costs insurers and consumers less than conventional care.¹

Patients utilizing naturopathic medicine report much higher patient satisfaction and health improvement, as compared to conventional care.²

SOURCE: 1 Tais S, Oberg E. (2013) The Economic Evaluation of Complementary and Alternative Medicine. Natural Medicine Journal.

SOURCE: 2 Stewart, D., Weeks, J., & Bent, S. (2001). Utilization, patient satisfaction, and cost implications of acupuncture, massage, and naturopathic medicine offered as covered health benefits: a comparison of two delivery models. Alternative therapies in health and medicine, 7(4), 66.

Naturopathic Medicine for the Prevention of Type 2 Diabetes

Research shows that naturopathic medicine improves blood glucose control, patient self-management behaviors, and self-efficacy among patients with diabetes

SOURCE: Boon, Heather, et al. “Visiting family physicians and naturopathic practitioners. Comparing patient-practitioner interactions.” Canadian family physician 49.11 (2003):1481-1487.

Naturopathic doctors address lifestyle modification (dietary recommendations, exercise prescriptions and stress reduction techniques) with 69-100% of their diabetic patients.

SOURCE: Bradley R. Adjunctive naturopathic care for type 2 diabetes: patient-reported & clinical outcomes after 1 year. BMC Complementary & Alternative Medicine 2012, 12:44

Patients under an ND’s care are 17% less likely to develop metabolic syndrome than those in conventional care.

SOURCE: Bradley R, Shen E, Buckle H, Kaltunas J, Tais S, Standish LJ. Description of clinical risk factor changes during naturopathic care for type 2 diabetes. J Altern Complement Med 2009;15:633–8.

The Diabetes Prevention Trial demonstrated that the prevention of type 2 diabetes by diet and lifestyle therapies was more cost effective than pharmaceutical therapy in high-risk patients. For each quality-adjusted life years (QALY) saved, a lifestyle modification program costs $8,800 while metformin therapy costs $29,000. Additionally, the lifestyle modification program was shown to be cost-effective in all adults, while metformin was not cost-effective after age 65.

SOURCE: Herman WH et al.; Diabetes Prevention Program Research Group. The cost-effectiveness of lifestyle modification or metformin in preventing type 2 diabetes in adults with impaired glucose tolerance. Ann Intern Med. 2005 Mar1; 142(5):323-32.

“CAM (Complimentary Alternative Medicine) users averaged $1,420 less in annual health care expenditures than nonusers in patients with the heaviest disease burden.”

SOURCE: Lind BK, Lafferty WE, Tyree WE, Diehr PK. 2010. Comparison of health care expenditures among insured users and nonusers of complementary and alternative medicine in Washington State: a cost minimization analysis. Journal of Alternative and Complementary Medicine. 16(4) 411-417

“Changes in lifestyle and stress reduction – a major focus of naturopathic medicine – could save the US $10 billion annually in reduced coronary angioplasty procedures and coronary bypass operations alone, and insurance savings of almost $30,000 per patient.”

SOURCE: Guarneri E, Horrigan BJ, Pechura CM. 2010. The efficacy and cost effectiveness of integrative medicine: A review of the medical and corporate literature. Bravewell Collaborative Report, June 2010

“Corporate health management programs associated with prevention and wellness showed a 26% reduction in health care costs and a $5.81-$6 returned for every $1 invested.”

SOURCE: Lafferty WE, Patrick TT, Bellas AS, Watts CA, Lind BK, Sherman KJ, Cherkin DC, Grembowski DE. 2006. Insurance coverage and subsequent utilization of Complementary and Alternative Medicine providers. American Journal of Managed Care. 12: 397-404.

A Blue Shield of Washington study found that “utilizing NDs as PCPs would reduce cost for chronic and stress-related illness up to 40% and cut costs of specialist utilization by 30%.”

SOURCE: Henry. 1995. King County Medical Blue Shield Phase 1 Final Report: Alternative Healthcare Project Steering Committee. August 5, 1995.

Another comparison revealed a $356 annual health cost savings for each user of Complementary and Alternative Medicine (CAM) when compared to CAM nonusers.

Evidence shows that Naturopathic doctors treated 7 of the top 10 most expensive health conditions more cost effectively than MDs or other conventional providers.

SOURCE: Henny, Geoffrey C., Alternative Health Care Consultant, King County Medical Blue Shield (KCMBS), Phase I Final Report: Alternative Healthcare Project, 1995

Naturopathic Medicine Improves Lower Back Pain and Other Musculoskeletal Complaints, Getting People Back to Work at Lower Costs

Ineffective pain care cost U.S. employers $297.4 to $335.5 billion in lost productivity in 2010.

SOURCE: Institute of Medicine of the National Academies Report. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research, 2011. The National Academies Press, Washington DC. (page 260). http://books.nap.edu/openbook.php?record_id=13172&page=260

A randomized controlled trial found significant decreases in pain and increases in range of motion in workers who received naturopathic care versus usual care. Quality of life also improved (p<0.0001).

SOURCE: Szczurko, Orest, et al. “Naturopathic care for chronic low back pain: a randomized trial.” PLoS One 2.9 (2007): e919.

A randomized controlled trial of rotator cuff tendinitis found reduced pain (p<0.001) and less disability (p=0.0002) among postal workers treated by naturopathic doctors compared to usual care.¹⁶

SOURCE: Naturopathic Treatment of Rotator Cuff Tendinitis Among Canadian Postal Workers: A Randomized Controlled Trial. Arthritis & Rheumatism (Arthritis Care & Research), Vol. 61, No. 8, August 15, 2009, pp 1037–1045.

Compared to conventional physiotherapy, naturopathic care was associated with improvements in symptoms and quality of life, as well as a decrease in costs of $1,212 per study participant. Workplace absenteeism was also reduced by 6.7 days per year.

SOURCE: Herman PM, Szczurko O, Cooley K, Mills EJ. Cost-effectiveness of naturopathic care for chronic low back pain.Altern Ther Health Med 2008; 14(2): 32-39.

From the perspective of the employer, the inclusion of naturopathic care in an essential benefits package could avoid $172 per day of lost productivity at a cost $154 per absentee day avoided, equal to a return on investment (ROI) of 7.9%.

SOURCE: Herman PM, Szczurko O, Cooley K, Mills EJ. Cost-effectiveness of naturopathic care for chronic low back pain.Altern Ther Health Med 2008; 14(2): 32-39.

Asthma

The total cost of asthma hospitalizations in New York State for 2007 was approximately $535 million, a 70% increase in the cost since 1998 ($315million)
Increasing evidence supports numerous naturopathic treatments for both the prevention and treatment of chronic lung conditions, including the use of fish oil supplements,^{1, 2} magnesium for acute symptoms,³ and nebulized glutathione.⁴

SOURCES: 1 Romieu, Isabelle, and Carol Trenga. “Diet and obstructive lung diseases.” Epidemiologic reviews 23.2 (2001): 268.

2 Dry, J., and D. Vincent. “Effect of a fish oil diet on asthma: results of a 1-year double-blind study.” International Archives of Allergy and Immunology 95.2-3 (2009): 156-157.

3 Hill, J., et al. “Investigation of the effect of short-term change in dietary magnesium intake in asthma.” European Respiratory Journal 10.10 (1997): 2225-2229.

4 Bishop, Clark, et al. “A pilot study of the effect of inhaled buffered reduced glutathione on the clinical status of patients with cystic fibrosis.” CHEST Journal 127.1 (2005): 308-317.

High Quality Care at Low Cost to Insurance Premiums

Analysis on the impact of Washington State’s 1996 Every Category of Provider law found that the “impact [of including naturopathic doctors] on premiums was modest – generally less than 2%.”

SOURCES: Watts CA, Lafferty WE, Baden AC. The effect of mandating complementary and alternative medicine services on insurance benefits in Washington state. J AlternComplement Med. 2004; 10:1001-1008

After 6 years of insurance coverage of ND Primary Care Providers (PCPs) in WA state, visits to NDs made up just 1% of all outpatient provider visits but accounted for only 0.3% of the dollars paid out by insurers.

SOURCE: Lafferty, et al. Insurance Coverage and Subsequent Utilization of Complementary and Alternative Medicine Providers. Journal of Managed Care. July 2006

Naturopathic doctors delivering the same Medicaid services in Oregon are 57.5% more cost effective than MD/DO/NP PCPs providing the same services.

SOURCE: The Cost Effectiveness of Naturopathic Delivery of Oregon Medicaid Services Statistics provided by Leslie Hendrickson, Office of Medical Assistance. Feb 11, 1991

Next week’s article on the value of Naturopathic Medicine: Safety. Thank you for reading this article! Liked what you read? Tweet it, share it on Facebook, “like” it on Facebook, and pass it on!

*Thank you also to contributing authors Dr. Maura Henninger and Dr. Rick Brinkman

The Value of Naturopathic Medicine in New York: Cost-Effective Primary Care for Disease Prevention and Health Improvement–Part IV