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Table 2

The cost-effectiveness of “advice” (provide evidence-based information on prognosis, advise to remain active, provide information about effective self-care options)

Study IDComparative treatmentsDetails of economic evaluationResults of economic evaluation
Herman et al. [46]Advice (advice and back booklet)
Naturopathic care (acupuncture, relaxation) and back booklet
Type: CEA/CUA
Perspective: societal, employer and patient
Setting: Canada, 2005
Follow-up: 6 months
ICER for naturopathic care compared to advice:
 QALY (SF-6D) = naturopathic care and back booklet dominant (i.e. incurred lower costs and more effective) from societal and patient’s perspective
 Absenteeism = 154 (2005 USD) per absentee day avoided from employer’s perspective
Hlobil et al. [26]Advice
Advice plus graded activity using cognitive-behavioural principles
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)
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)
Karjalainen et al. [21, 22]GP care
GP care plus advice (advice, education, exercise)
Type and perspective: not stated
Setting: Finland 1998–2000
Follow-up: 24 months
No ICER conducted, but advice incurred lower costs and was more effective in proving daily symptoms, pain bothersomeness, satisfaction, days on sick leave (i.e. dominant).
Molde Hagen et al. [27]Advice (advice and simple exercises)
Usual care in primary care
Type: CBA
Perspective: societal
Setting: Norway, price year 1995
Follow-up: 1 year for costs, 3 years for other outcomes
Mean cost benefit = 3,497 (1995 USD) favouring advice
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 [mean (95% CI)]:
 Pain = 512 (2002 USD) per 1 point gained on a 100-point scale (77–949)
 Disability (Oswestry) = −78 (2002 USD) per 1 point gained on a 100-point scale (−655 to 499)
Rivero-Arias et al. [38]Advice
Physiotherapy
Type: CEA/CUA
Perspective: unspecified for ICER
Setting: United Kingdom, 1997–2001
Follow-up: 1 year
ICER for physiotherapy compared to advice:
 3,010 (2004 GBP) per QALY gained (EQ-5D)
Strong et al. [20] for Moore et al. [18]Book on back pain care
Advice (psychologist-led group education sessions)
Type: CEA/CUA
Perspective: health insurer
Setting: United States, 1996–1997
Follow-up: 1 year
ICER for advice compared to book [mean (95% CI)]:
 6.13 (USD, price year not reported) per one low-impact back pain days (1.48–21.14)
Strong et al. [20] for von Korff et al. [19]Book on back pain care
Advice (layperson-led group education sessions)
Type: CEA/CUA
Perspective: health insurer
Setting: United States, 1996–1997
Follow-up: 1 year
ICER for advice compared to book [mean (95% CI)]:
 9.70 (USD, price year not reported) per one low-impact back pain days (−45.45 to 78.86)

The study included other comparison groups. Only data from the specified groups were included

CBA cost-benefit analysis, CEA cost-effectiveness analysis, CUA cost-utility analysis, GBP British pounds, GP care care provided by a general practitioner or a primary care physician, ICER incremental cost-effectiveness ratio, in cost per 1 unit of effect gained, LBP low back pain, QALY quality-adjusted life-years, USD United States dollars

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