Cost Effectiveness of Physical Treatments
for Back Pain in Primary Care

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:   Frankp@chiro.org

FROM:   British Medical Journal 2004 (Dec 11);   329 (7479):   1381 ~ FULL TEXT

Findings from the:
“United Kingdom Back Pain Exercise and Manipulation (UK BEAM) Randomised Trial”


DISCUSSION:

We believe that this is the first study of physical therapy for low back pain to show convincingly that both manipulation alone and manipulation followed by exercise provide cost effective additions to care in general practice. Indeed, as we trained practice teams in the best care of back pain, we may have underestimated the benefit of physical therapy (spinal manipulation) when compared with "usual care" in general practice. The detailed clinical outcomes reported in the accompanying paper reinforce these findings by showing that the improvements in health status reported here reflect statistically significant improvements in function, pain, disability, physical and mental aspects of quality of life, and beliefs about back pain. [1]


Read more about this on the UK BEAM Trial Page


OBJECTIVE:   To assess the cost effectiveness of adding spinal manipulation, exercise classes, or manipulation followed by exercise ("combined treatment") to "best care" in general practice for patients consulting with low back pain.

DESIGN:   Stochastic cost utility analysis alongside pragmatic randomised trial with factorial design.

SETTING:   181 general practices and 63 community settings for physical treatments around 14 centres across the United Kingdom.

PARTICIPANTS:   1287 (96%) of 1334 trial participants.

MAIN OUTCOME MEASURES:   Healthcare costs, quality adjusted life years (QALYs), and cost per QALY over 12 months.

RESULTS:   Over one year, mean treatment costs relative to "best care" were 195 pounds sterling (360 dollars; 279 euros; 95% credibility interval 85 pounds sterling to 308 pounds sterling) for manipulation, 140 pounds sterling (3 pounds sterling to 278 pounds sterling) for exercise, and 125 pounds sterling (21 pounds sterling to 228 pounds sterling) for combined treatment. All three active treatments increased participants' average QALYs compared with best care alone. Each extra QALY that combined treatment yielded relative to best care cost 3800 pounds sterling; in economic terms it had an "incremental cost effectiveness ratio" of 3800 pounds sterling. Manipulation alone had a ratio of 8700 pounds sterling relative to combined treatment. If the NHS was prepared to pay at least 10,000 pounds sterling for each extra QALY (lower than previous recommendations in the United Kingdom), manipulation alone would probably be the best strategy. If manipulation was not available, exercise would have an incremental cost effectiveness ratio of 8300 pounds sterling relative to best care.

CONCLUSIONS:   Spinal manipulation is a cost effective addition to "best care" for back pain in general practice. Manipulation alone probably gives better value for money than manipulation followed by exercise.

Return to the LOW BACK PAIN Section

Return to the COST-EFFECTIVENESS Section

Return to "Spinal Manipulation Gives Value for Money"

Since 1-16-2005