title: Cost-effectiveness of general practice care for low back pain: a systematic review.
abstract: Care from a general practitioner (GP) is one of the most frequently utilised healthcare services for people with low back pain and only a small proportion of those with low back pain who seek care from a GP are referred to other services. The aim of this systematic review was to evaluate the evidence on cost-effectiveness of GP care in non-specific low back pain. We searched clinical and economic electronic databases, and the reference list of relevant systematic reviews and included studies to June 2010. Economic evaluations conducted alongside randomised controlled trials with at least one GP care arm were eligible for inclusion. Two reviewers independently screened search results and extracted data. Eleven studies were included; the majority of which conducted a cost-effectiveness or cost-utility analysis. Most studies investigated the cost-effectiveness of usual GP care. Adding advice, education and exercise, or exercise and behavioural counselling, to usual GP care was more cost-effective than usual GP care alone. Clinical rehabilitation and/or occupational intervention, and acupuncture were more cost-effective than usual GP care. One study investigated the cost-effectiveness of guideline-based GP care, and found that adding exercise and/or spinal manipulation was more cost-effective than guideline-based GP care alone. In conclusion, GP care alone did not appear to be the most cost-effective treatment option for low back pain. GPs can improve the cost-effectiveness of their treatment by referring their patients for additional services, such as advice and exercise, or by providing the services themselves.
authors.affiliation: The George Institute for Global Health and Sydney Medical School, The University of Sydney, PO Box M201, Missenden Rd, Sydney, NSW 2050, Australia. clin@george.org.au
authors.forename: Chung-Wei Christine
authors.initials: CW
authors.lastname: Lin
authors.forename: Marion
authors.initials: M
authors.lastname: Haas
authors.forename: Chris G
authors.initials: CG
authors.lastname: Maher
authors.forename: Luciana A C
authors.initials: LA
authors.lastname: Machado
authors.forename: Maurits W
authors.initials: MW
authors.lastname: van Tulder
mesh_terms: D003362:Cost-Benefit Analysis; D005081:Exercise Therapy / Q000191:economics; D058006:General Practice / Q000191:economics*; D058005:General Practitioners / Q000191:economics; D006801:Humans; D017116:Low Back Pain / Q000191:economics* / Q000534:rehabilitation*; D010818:Practice Patterns, Physicians' / Q000191:economics* / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic; D012017:Referral and Consultation / Q000191:economics / Q000706:statistics & numerical data