| PMC full text: | Published online 2011 Jan 13. doi: 10.1007/s00586-010-1676-3
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Table 3
The cost-effectiveness of interdisciplinary rehabilitation, exercise, spinal manipulation and cognitive-behavioural therapy (CBT) for sub-acute or chronic low back pain
| Study | Comparative treatments | Details of economic evaluation | Results of economic evaluation |
|---|---|---|---|
| Critchley et al. [33] | Physiotherapy Spinal stabilization exercises Pain management programme using CBT | Type: CEA/CUA Perspective: healthcare sector Setting: United Kingdom, 2002–2005 Follow-up: 18 months | No raw data reported, but pain management programme associated with least costs and acceptability curve shows that it is likely to be most cost-effective |
| Hlobil et al. [26] | Advice Advice plus graded activity using CBT | Type: CBA Perspective: employer Setting: The Netherlands, 1999–2000 Follow-up: 1 year for costs, 3 years for other outcomes | Mean cost benefit = 999 (1999 Euro) favouring advice plus graded activity (95% CI −1,073 to 3,115) |
| Hollinghurst et al. [34] | GP care GP care plus exercise and behavioural counselling | Type: CEA/CUA Perspective: healthcare sector, patients, societal Setting: United Kingdom 2002–2004 Follow-up: 18 months | ICER for GP care plus exercise and behavioural counselling compared to GP care (in 2005 GBP per 1 unit of effect gained, from the healthcare sector’s perspective only): Disability (RMDQ) = 61 Pain-free days = 9 QALY gained (EQ-5D) = 2,847 |
| Johnson et al. [35] | GP care Exercise and education using CBT | Type: CEA/CUA Perspective: not stated Setting: United Kingdom 2002–2003 Follow-up: 15 months | ICER for exercise and education using CBT compared to GP care: 5,000 (2003–2004 GBP) per QALY gained (EQ-5D) |
| Kominski et al. [30] | GP care Chiropractic care (manipulation, instruction in back care and exercise) | Type: CMA Perspective: not stated Setting: United States 1995–1998 Follow-up: 18 months | Costs over 18 months in USD [price year not stated, mean (SD)]: GP care = 463 (1,225) Chiropractic care = 550 (834) GP care significantly cheaper |
| Lamb et al. [36] | Group cognitive behavioural intervention plus advice Advice | Type: CEA/CUA Perspective: healthcare sector Setting: United Kingdom, price year 2008 Follow-up: 1 year | ICER for Group cognitive behavioural intervention plus advice = 1,786 (2008 GBP) per QALY gained (EQ-5D) |
| Loisel et al. [25] | GP care Clinical rehabilitation (back pain specialist, back school ± multidisciplinary rehabilitation) | Type: CEA/CUA and CBA Perspective: insurance provider Setting: Canada 1991–1993 Follow-up: mean 6.4 years | ICER for treatments compared to GP care (in 1998 Canadian dollars per 1 day on full benefit): Clinical rehabilitation = −67.6 dominant |
| Niemisto et al. [23, 24] | Advice (advice, education and simple exercises) Advice plus manipulation and stabilizing exercises | Type: CEA/CUA Perspective: societal Setting: Finland, study initiated in 1999 Follow-up: 2 years | ICER for advice plus manipulation and stabilizing exercises compared to advice [in 2002 USD per 1 point gained, mean (95% CI)]: Pain (0–100) = 512 (77–949) Disability (Oswestry, 0–100) = −78 (−655 to 499) |
| Rivero-Arias et al. [39] | Outpatient rehabilitation Spinal surgery | Type: CEA/CUA Perspective: healthcare sector and patient Setting: United Kingdom, 1996–2002 Follow-up: 2 years | ICER for spinal surgery compared to outpatient rehabilitation [in 2002–2003 GBP]: 48,588 per QALY gained (95% CI −279,883 to 372,406) |
| Schweikert et al. [44] | Inpatient rehabilitation Inpatient rehabilitation plus CBT | Type: CEA/CUA Perspective: societal Setting: Germany, price year 2001 Follow-up: 6 months | ICER for inpatient rehabilitation plus CBT compared to inpatient rehabilitation −126,731 (2001 Euro) per QALY gained (EQ-5D, dominant) |
| Skouen et al. [28] | GP care Light interdisciplinary rehabilitation Extensive interdisciplinary rehabilitation | Type: CBA Perspective: societal Setting: Norway 1996–1997 Follow-up: 2 years after end of treatment | Cost benefit for treatments compared to GP care: Light interdisciplinary rehabilitation in male patients = 7,240,900 (1998 Norwegian kroner) for the male participants (n = 21) over 24 months Extensive interdisciplinary rehabilitation —no data reported |
| Torstensen et al. [29] | Medical exercise therapy Physiotherapy Walking | Type: CBA Perspective: not reported Setting: Norway, 1993–1996 Follow-up: 15 months | Cost benefit compared to walking in Norwegian Kroner (price year not reported): Medical exercise therapy (n = 69) = 906,732 less Physiotherapy (n = 67) = 1,882,560 less |
| UK BEAM Trial Team [40] | GP care GP care plus exercise GP care plus manipulation GP care plus manipulation followed by exercise | Type: CEA/CUA Perspective: healthcare sector Setting: United Kingdom, 1999–2002 Follow-up: 1 year | ICER for treatments compared to GP care [in 2000–2001 GBP per QALY gained (EQ-5D)]: GP care plus exercise = 8,300 GP care plus manipulation = 4,800 GP care plus manipulation followed by exercise = 3,800 |
| Van der Roer et al. [43] | Exercise and back school (using behavioural principles) Physiotherapy | Type: CEA/CUA Perspective: societal Setting: The Netherlands, price year 2004 Follow-up: 1 year | ICER for exercise and back school compared to physiotherapy (in 2004 Euro per unit of effect gained): Disability (RMDQ) = 16,349 Pain (numerical rating scale) = −175 (dominant) Perceived effects (Global perceived effects scale) = 1,720 QALY (EQ-5D) = 5,141 |
| Whitehurst et al. [32] | Physiotherapy Pain management programme using CBT | Type: CEA/CUA Perspective: healthcare sector Setting: United Kingdom, price years 2001–2002 Follow-up: 1 year | ICER for physiotherapy compared to pain management (in 2001–2002 GBP per unit of effect gained): Disability (RMDQ) = 156 QALY (EQ-5D) = 2,362 |