Cost-effectiveness of guideline-endorsed treatments for low back pain: a systematic review

Abstract

Healthcare costs for low back pain (LBP) are increasing rapidly. Hence, it is important to provide treatments that are effective and cost-effective. The purpose of this systematic review was to investigate the cost-effectiveness of guideline-endorsed treatments for LBP. We searched nine clinical and economic electronic databases and the reference list of relevant systematic reviews and included studies for eligible studies. Economic evaluations conducted alongside randomised controlled trials investigating treatments for LBP endorsed by the guideline of the American College of Physicians and the American Pain Society were included. Two independent reviewers screened search results and extracted data. Data extracted included the type and perspective of the economic evaluation, the treatment comparators, and the relative costeffectiveness of the treatment comparators. Twenty-six studies were included. Most studies found that interdisciplinary rehabilitation, exercise, acupuncture, spinal manipulation or cognitive-behavioural therapy were costeffective in people with sub-acute or chronic LBP. Massage alone was unlikely to be cost-effective. There were inconsistent results on the cost-effectiveness of advice, insufficient evidence on spinal manipulation for people with acute LBP, and no evidence on the cost-effectiveness of medications, yoga or relaxation. This review found evidence supporting the cost-effectiveness of the guidelineendorsed treatments of interdisciplinary rehabilitation, exercise, acupuncture, spinal manipulation and cognitivebehavioural therapy for sub-acute or chronic LBP. There is little or inconsistent evidence for other treatments endorsed in the guideline.

Cost-effectiveness of physiotherapeutic interventions for low back pain: a systematic review

“…Our findings were compared to those of previous review of cost-effectiveness physiotherapy interventions or treatments for low back pain [14]. Parallel to the findings of the current review, previous literature found evidence to support that interdisciplinary rehabilitation, exercise, acupuncture, spinal manipulation, and cognitive behavioural therapy were cost-effective in patients with LBP.…”

“…Economic evaluation as a tool, for example, aims to improve the efficiency of healthcare resources in relation to physiotherapy interventions [13]. In previous reviews [6], a guideline endorsing treatments of interdisciplinary rehabilitation, exercise, acupuncture, spinal manipulation, and cognitive behavioural therapy was shown to be cost-effective for patients with chronic LBP [14]. However, there is inconsistency and lack of evidence on the costeffectiveness of some physiotherapy interventions including advisory consultation, medications, massage and yoga or relaxation.…”

The effects of multimodal rehabilitation on pain-related sickness absence – an observational study

“…Multimodal rehabilitation has shown evidence of reducing symptoms and disability [8,9]. The effects on sickness absence and work return are less consistent, but several studies have demonstrated reduced sickness absence after multimodal rehabilitation [10], while analyses of cost-effectiveness, including longitudinal follow-up studies [11] and analyses of cost-effectiveness have been positive [12]. Persons with less complex chronic pain conditions may benefit from unimodal treatments, i.e., physiotherapy, exercise or cognitive-behavioral therapy [13,14].…”