title: Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial.
abstract: OBJECTIVE
  To evaluate the cost effectiveness of physiotherapy, manual therapy, and care by a general practitioner for patients with neck pain.
  
  
  METHODS
  Economic evaluation alongside a randomised controlled trial.
  
  
  METHODS
  Primary care.
  
  
  METHODS
  183 patients with neck pain for at least two weeks recruited by 42 general practitioners and randomly allocated to manual therapy (n=60, spinal mobilisation), physiotherapy (n=59, mainly exercise), or general practitioner care (n=64, counselling, education, and drugs).
  
  
  METHODS
  Clinical outcomes were perceived recovery, intensity of pain, functional disability, and quality of life. Direct and indirect costs were measured by means of cost diaries that were kept by patients for one year. Differences in mean costs between groups, cost effectiveness, and cost utility ratios were evaluated by applying non-parametric bootstrapping techniques.
  
  
  RESULTS
  The manual therapy group showed a faster improvement than the physiotherapy group and the general practitioner care group up to 26 weeks, but differences were negligible by follow up at 52 weeks. The total costs of manual therapy (447 euro; 273 pounds sterling; 402 dollars) were around one third of the costs of physiotherapy (1297 euro) and general practitioner care (1379 euro). These differences were significant: P<0.01 for manual therapy versus physiotherapy and manual therapy versus general practitioner care and P=0.55 for general practitioner care versus physiotherapy. The cost effectiveness ratios and the cost utility ratios showed that manual therapy was less costly and more effective than physiotherapy or general practitioner care.
  
  
  CONCLUSIONS
  Manual therapy (spinal mobilisation) is more effective and less costly for treating neck pain than physiotherapy or care by a general practitioner.
authors.affiliation: Institute for Research in Extramural Medicine, VU University Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, Netherlands. ibc.korthals-de_bos.emgo@med.vu.nl
authors.forename: Ingeborg B C
authors.initials: IB
authors.lastname: Korthals-de Bos
authors.forename: Jan L
authors.initials: JL
authors.lastname: Hoving
authors.forename: Maurits W
authors.initials: MW
authors.lastname: van Tulder
authors.forename: Maureen P M H
authors.initials: MP
authors.lastname: Rutten-van Mölken
authors.forename: Herman J
authors.initials: HJ
authors.lastname: Adèr
authors.forename: Henrica C W
authors.initials: HC
authors.lastname: de Vet
authors.forename: Bart W
authors.initials: BW
authors.lastname: Koes
authors.forename: Hindrik
authors.initials: H
authors.lastname: Vondeling
authors.forename: Lex M
authors.initials: LM
authors.lastname: Bouter
mesh_terms: D000041:Absenteeism; D000293:Adolescent; D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D005194:Family Practice / Q000191:economics*; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D020393:Manipulation, Spinal / Q000191:economics*; D008875:Middle Aged; D019547:Neck Pain / Q000191:economics / Q000534:rehabilitation*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D026741:Physical Therapy Modalities / Q000191:economics*; D012680:Sensitivity and Specificity; D016896:Treatment Outcome