Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial.
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.
Korthals-de Bos
Ingeborg B C
IB
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
Hoving
Jan L
JL
van Tulder
Maurits W
MW
Rutten-van Mölken
Maureen P M H
MP
Adèr
Herman J
HJ
de Vet
Henrica C W
HC
Koes
Bart W
BW
Vondeling
Hindrik
H
Bouter
Lex M
LM
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