title: Which interventions are cost-effective for the management of whiplash-associated and neck pain-associated disorders? A systematic review of the health economic literature by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.
abstract: Whiplash-associated disorders (WAD) and neck pain and associated disorders (NAD) are prevalent conditions that impact society and impose a significant economic burden on health-care systems. Health economic evidence on WAD and NAD interventions has been sparse: only three economic evaluations of interventions for NAD were identified by the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders (NPTF). An updated overview is needed to inform health-care policy and guidelines.
  
  
  
  This study aimed to determine the cost-effectiveness of interventions for grades I-III WAD and NAD in children and adults.
  
  
  
  Systematic review of health economic literature, best-evidence synthesis.
  
  
  
  We systematically searched CINAHL, the Cochrane economic databases (Health Technology Assessment, NHS Economic Evaluation Database), EconLit, EMBASE, MEDLINE, PsycINFO, and Tufts CEA Registry from 2000 to 2015 for economic evaluations of WAD and NAD interventions. We appraised relevant evaluations using the Scottish Intercollegiate Guidelines Network Methodology Criteria for Economic Evaluations. We extracted data, including mean costs (standardized to 2013 Canadian dollars [CAD]) and quality-adjusted life years (QALYs), from studies with adequate methodological quality. We recalculated cost-effectiveness statistics based on the standardized currency using a willingness-to-pay of CAD $50,000 per additional QALY. Funding was provided by the Ministry of Finance.
  
  
  
  Our search identified 1,616 citations. Six studies fulfilled our selection criteria, including three studies previously reviewed by the NPTF. Structured education appears cost-effective for adults with WAD. For adults with NAD, acupuncture added to routine medical care; manual therapy; multimodal care that includes manual therapy; advice and exercise; and psychological care using cognitive-behavioral therapy appear cost-effective. In contrast, adding manual therapy or diathermy to advice and exercise; multimodal care by a physiotherapist or physician; and behavioral-graded activity do not appear cost-effective for adults with NAD.
  
  
  
  Our review adds to the findings of the NPTF. Recent evidence suggests that structured education is cost-effective for WAD, whereas advice and exercise and multimodal care that include manual therapy are cost-effective for NAD. Obtaining more robust health economic evidence for non-invasive interventions for WAD and NAD in children and adults remains an essential research priority.
authors.affiliation: Toronto Health Economics and Technology Assessment (THETA) Collaborative, Leslie Dan Pharmacy Building, University of Toronto, 6th Floor, Room 658, 144 College Street, Toronto, Ontario, M5S 3M2, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, Ontario, M5S 3M2, Canada; Institute for Work and Health, 481 University Avenue, Toronto, Ontario, M5G 2E9, Canada.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: van der Velde
authors.affiliation: UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario, M2H 3J1, Canada; Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario, M2H 3J1, Canada.
authors.forename: Hainan
authors.initials: H
authors.lastname: Yu
authors.affiliation: Faculty of Medicine and Dentistry, University of Alberta, 2J2.00 Walter C Mackenzie Health, Sciences Centre, 8440 112 St. NW, Edmonton, Alberta, T6G 2R7, Canada.
authors.forename: Mike
authors.initials: M
authors.lastname: Paulden
authors.affiliation: UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario, M2H 3J1, Canada; Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe St N, Science building, Room 3000, Oshawa, Ontario, L1H 7K4, Canada; Canada Research Chair in Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000 Simcoe St N, Science building, Room 3000, Oshawa, Ontario, L1H 7K4, Canada. Electronic address: Pierre.Cote@uoit.ca.
authors.forename: Pierre
authors.initials: P
authors.lastname: Côté
authors.affiliation: UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario, M2H 3J1, Canada; Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario, M2H 3J1, Canada.
authors.forename: Sharanya
authors.initials: S
authors.lastname: Varatharajan
authors.affiliation: UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario, M2H 3J1, Canada; Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario, M2H 3J1, Canada.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Shearer
authors.affiliation: UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario, M2H 3J1, Canada; Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario, M2H 3J1, Canada.
authors.forename: Jessica J
authors.initials: JJ
authors.lastname: Wong
authors.affiliation: UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario, M2H 3J1, Canada; Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario, M2H 3J1, Canada; Division of Undergraduate Education, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario, M2H 3J1, Canada.
authors.forename: Kristi
authors.initials: K
authors.lastname: Randhawa
authors.affiliation: UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario, M2H 3J1, Canada; Division of Undergraduate Education, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario, M2H 3J1, Canada.
authors.forename: Danielle
authors.initials: D
authors.lastname: Southerst
authors.affiliation: Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario, M2H 3J1, Canada; Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe St N, Science building, Room 3000, Oshawa, Ontario, L1H 7K4, Canada.
authors.forename: Silvano
authors.initials: S
authors.lastname: Mior
authors.affiliation: UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario, M2H 3J1, Canada; Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario, M2H 3J1, Canada.
authors.forename: Deborah
authors.initials: D
authors.lastname: Sutton
authors.affiliation: UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario, M2H 3J1, Canada; Division of Clinical Education, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario, M2H 3J1, Canada.
authors.forename: Craig
authors.initials: C
authors.lastname: Jacobs
authors.affiliation: UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario, M2H 3J1, Canada.
authors.forename: Anne
authors.initials: A
authors.lastname: Taylor-Vaisey
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy / Q000191:economics*; D003362:Cost-Benefit Analysis; D005081:Exercise Therapy / Q000191:economics*; D006801:Humans; D019547:Neck Pain / Q000209:etiology / Q000534:rehabilitation* / Q000628:therapy; D011613:Psychotherapy / Q000191:economics*; D000078202:Systematic Reviews as Topic; D014911:Whiplash Injuries / Q000150:complications / Q000534:rehabilitation* / Q000628:therapy
keywords: Cost-effectiveness; Economic evaluation; Intervention; Neck pain; Systematic review; Whiplash