Systematic review of the cost-effectiveness of treatments for low back pain
Key Objective
To undertake a systematic review of the literature on the cost-effectiveness of alternative treatments for non-specific low back pain
Low back pain (LBP) is a common health condition which affects most adults at some point during their lifetime (1). For most patients in primary care, the source of symptoms cannot be specified and the patient receives the label non-specific LBP. Most individuals with non-specific low back pain receive all or part of their care from a primary care physician or GP and understanding the relative cost-effectiveness of alternative treatments is important. Recently, the American College of Physicians and the American Pain Society published a joint clinical guideline which recommended a range of interventions as effective; in this instance, additional information on the relative cost-effectiveness of the recommended treatments will be useful for decision makers.
Relevant articles were obtained by searching nine clinical and economic electronic databases, and the reference list of relevant systematic reviews and included studies to February 2009. Economic evaluations conducted alongside randomised controlled trials were eligible for inclusion. Eleven studies were included in the review of GP care; the results indicated that GP care alone did not appear to be the most cost-effective treatment option for low back pain. Twenty-five studies were included in the review of the cost-effectiveness of guidelines-endorsed care. Evidence supports the cost-effectiveness of some guideline-endorsed treatments: interdisciplinary rehabilitation, exercise, acupuncture, spinal manipulation and cognitive-behavioural therapy for sub-acute or chronic LBP. However, there were inconsistent results on the cost-effectiveness of advice, insufficient evidence on spinal manipulation for people with acute low back pain, and no evidence on the cost-effectiveness of medications, yoga or relaxation.
Two journal articles have been published in the European Spine Journal.
1. Lin, C., Haas, M.R., Maher, G., Machado, L. & van Tulder, M. 2011, 'Cost-effectiveness of general practice care for low back pain: A systematic review', European Spine Journal, vol. 20, no. 7, pp. 1012-1023.
2. Lin, C., Haas, M.R., Maher, G., Machado, L. & van Tulder, M. 2011, 'Cost-effectiveness of guideline-endorsed treatments for low back pain: A systematic review', European Spine Journal, vol. 20, no. 7, pp. 1024-1038.
Funding source
Internal funds
CHERE staff
Marion Haas
Collaborators
Christine Lin1, Chris Maher1, Luciana Machado2, Maurits W van Tulder3
1. George Institute, University of Sydney
2. Universidade Federal de Minas Gerais, Brazil
3. Department of Health Sciences and the EMGO Institute for Health and Care Research, Faculty of Earth & Life Sciences, VU University, The Netherlands
