title: Cost-utility analysis of osteopathy in primary care: results from a pragmatic randomized controlled trial.
abstract: BACKGROUND
  Spinal pain is common and costly to health services and society. Management guidelines have encouraged primary care referral for spinal manipulation, but the evidence base is weak. More economic evaluations alongside pragmatic trials have been recommended.
  
  
  OBJECTIVE
  Our aim was to assess the cost-utility of a practice-based osteopathy clinic for subacute spinal pain.
  
  
  METHODS
  A cost-utility analysis was performed alongside a pragmatic single-centre randomized controlled trial in a primary care osteopathy clinic accepting referrals from 14 neighbouring practices in North West Wales. Patients with back pain of 2-12 weeks duration were randomly allocated to treatment with osteopathy plus usual GP care or usual GP care alone. Costs were measured from a National Health Service (NHS) perspective. All primary and secondary health care interventions recorded in GP notes were collected for the study period. We calculated quality adjusted life year (QALY) gains based on EQ-5D responses from patients in the trial, and then cost per QALY ratios. Confidence intervals (CIs) were estimated using non-parametric bootstrapping.
  
  
  RESULTS
  Osteopathy plus usual GP care was more effective but resulted in more health care costs than usual GP care alone. The point estimate of the incremental cost per QALY ratio was 3560 pounds (80% CI 542 pounds-77,100 pounds). Sensitivity analysis examining spine-related costs alone and total costs excluding outliers resulted in lower cost per QALY ratios.
  
  
  CONCLUSIONS
  A primary care osteopathy clinic may be a cost-effective addition to usual GP care, but this conclusion was subject to considerable random error. Rigorous multi-centre studies are needed to assess the generalizability of this approach.
authors.affiliation: Department of General Practice, University of Wales College of Medicine, Cardiff University, Wescram, UK. williamsnh@cardiff.ac.uk
authors.forename: Nefyn H
authors.initials: NH
authors.lastname: Williams
authors.forename: Rhiannon T
authors.initials: RT
authors.lastname: Edwards
authors.forename: Pat
authors.initials: P
authors.lastname: Linck
authors.forename: Rachel
authors.initials: R
authors.lastname: Muntz
authors.forename: Richard
authors.initials: R
authors.lastname: Hibbs
authors.forename: Clare
authors.initials: C
authors.lastname: Wilkinson
authors.forename: Ian
authors.initials: I
authors.lastname: Russell
authors.forename: Daphne
authors.initials: D
authors.lastname: Russell
authors.forename: Barry
authors.initials: B
authors.lastname: Hounsome
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001416:Back Pain / Q000191:economics* / Q000534:rehabilitation; D003362:Cost-Benefit Analysis; D005194:Family Practice / Q000191:economics* / Q000379:methods; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000191:economics* / Q000534:rehabilitation; D010021:Osteopathic Medicine / Q000191:economics* / Q000379:methods; D010147:Pain Measurement; D011320:Primary Health Care / Q000191:economics / Q000379:methods; D019057:Quality-Adjusted Life Years; D012647:Self-Assessment; D013222:State Medicine; D018709:Statistics, Nonparametric; D014852:Wales