title: Cost-effectiveness of manual therapy versus physiotherapy in patients with sub-acute and chronic neck pain: a randomised controlled trial.
abstract: To evaluate the cost-effectiveness of manual therapy according to the Utrecht School (MTU) in comparison with physiotherapy (PT) in sub-acute and chronic non-specific neck pain patients from a societal perspective.
  
  
  
  An economic evaluation was conducted alongside a 52-week randomized controlled trial, in which 90 patients were randomized to the MTU group and 91 to the PT group. Clinical outcomes included perceived recovery (yes/no), functional status (continuous and yes/no), and quality-adjusted life-years (QALYs). Costs were measured from a societal perspective using self-reported questionnaires. Missing data were imputed using multiple imputation. To estimate statistical uncertainty, bootstrapping techniques were used.
  
  
  
  After 52 weeks, there were no significant between-group differences in clinical outcomes. During follow-up, intervention costs (β:€-32; 95 %CI: -54 to -10) and healthcare costs (β:€-126; 95 %CI: -235 to -32) were significantly lower in the MTU group than in the PT group, whereas unpaid productivity costs were significantly higher (β:€186; 95 %CI:19-557). Societal costs did not significantly differ between groups (β:€-96; 95 %CI:-1975-2022). For QALYs and functional status (yes/no), the maximum probability of MTU being cost-effective in comparison with PT was low (≤0.54). For perceived recovery (yes/no) and functional status (continuous), a large amount of money must be paid per additional unit of effect to reach a reasonable probability of cost-effectiveness.
  
  
  
  From a societal perspective, MTU was not cost-effective in comparison with PT in patients with sub-acute and chronic non-specific neck pain for perceived recovery, functional status, and QALYs. As no clear total societal cost and effect differences were found between MTU and PT, the decision about what intervention to administer, reimburse, and/or implement can be based on the preferences of the patient and the decision-maker at hand.
  
  
  
  ClinicalTrials.gov Identifier: NCT00713843.
authors.affiliation: Department of Health Sciences & EMGO+ Institute for Health and Care Research, Faculty of Earth & Life Sciences, VU University Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands. j.m.van.dongen@vu.nl.
authors.forename: J M
authors.initials: JM
authors.lastname: van Dongen
authors.affiliation: Department of Health Sciences & EMGO+ Institute for Health and Care Research, Faculty of Earth & Life Sciences, VU University Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands.|Scientific Institute for Quality of Health Care, Radboud University Nijmegen Medical Centre, Geert Grooteplein 21, 6525 EZ, Nijmegen, The Netherlands.|Avansplus, University for Professionals, Heerbaan 14-40, 4817 NL, Breda, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Groeneweg
authors.affiliation: Department of Health Sciences & EMGO+ Institute for Health and Care Research, Faculty of Earth & Life Sciences, VU University Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands.
authors.forename: S M
authors.initials: SM
authors.lastname: Rubinstein
authors.affiliation: Department of Health Sciences & EMGO+ Institute for Health and Care Research, Faculty of Earth & Life Sciences, VU University Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands.
authors.forename: J E
authors.initials: JE
authors.lastname: Bosmans
authors.affiliation: Scientific Institute for Quality of Health Care, Radboud University Nijmegen Medical Centre, Geert Grooteplein 21, 6525 EZ, Nijmegen, The Netherlands.|Department of Manual Therapy, Faculty of Medicine and Pharmacy, Free University of Brussels, Pleinlaan 2, 1050, Brussels, Belgium.
authors.forename: R A B
authors.initials: RA
authors.lastname: Oostendorp
authors.affiliation: Department of Health Sciences & EMGO+ Institute for Health and Care Research, Faculty of Earth & Life Sciences, VU University Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands.|Department of Epidemiology and Biostatistics & the EMGO+ Institute for Health and Care Research, VU University Medical Center, De Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands.
authors.forename: R W J G
authors.initials: RW
authors.lastname: Ostelo
authors.affiliation: Department of Health Sciences & EMGO+ Institute for Health and Care Research, Faculty of Earth & Life Sciences, VU University Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands.|Department of Epidemiology and Biostatistics & the EMGO+ Institute for Health and Care Research, VU University Medical Center, De Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands.
authors.forename: M W
authors.initials: MW
authors.lastname: van Tulder
mesh_terms: D000328:Adult; D059350:Chronic Pain / Q000628:therapy*; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D026201:Musculoskeletal Manipulations / Q000191:economics / Q000379:methods*; D019547:Neck Pain / Q000628:therapy*; D009426:Netherlands; D026741:Physical Therapy Modalities / Q000191:economics; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires
keywords: Economic evaluation; Musculoskeletal manipulation; Physical therapy modalities