title: Cost-Effectiveness of Non-Invasive and Non-Pharmacological Interventions for Low Back Pain: a Systematic Literature Review.
abstract: BACKGROUND
  Low back pain (LBP) is a major health problem, having a substantial effect on peoples' quality of life and placing a significant economic burden on healthcare systems and, more broadly, societies. Many interventions to alleviate LBP are available but their cost effectiveness is unclear.
  
  
  OBJECTIVE
  To identify, document and appraise studies reporting on the cost effectiveness of non-invasive and non-pharmacological treatment options for LBP.
  
  
  METHODS
  Relevant studies were identified through systematic searches in bibliographic databases (EMBASE, MEDLINE, PsycINFO, Cochrane Library, CINAHL and the National Health Service Economic Evaluation Database), 'similar article' searches and reference list scanning. Study selection was carried out by three assessors, independently. Study quality was assessed using the Consensus on Health Economic Criteria checklist. Data were extracted using customized extraction forms.
  
  
  RESULTS
  Thirty-three studies were identified. Study interventions were categorised as: (1) combined physical exercise and psychological therapy, (2) physical exercise therapy only, (3) information and education, and (4) manual therapy. Interventions assessed within each category varied in terms of their components and delivery. In general, combined physical and psychological treatments, information and education interventions, and manual therapies appeared to be cost effective when compared with the study-specific comparators. There is inconsistent evidence around the cost effectiveness of physical exercise programmes as a whole, with yoga, but not group exercise, being cost effective.
  
  
  CONCLUSIONS
  The identified evidence suggests that combined physical and psychological treatments, medical yoga, information and education programmes, spinal manipulation and acupuncture are likely to be cost-effective options for LBP.
authors.affiliation: Health Economics Unit, Public Health Building, University of Birmingham, Birmingham, B15 2TT, UK. l.andronis@bham.ac.uk.
authors.forename: Lazaros
authors.identifier: http://orcid.org/0000-0001-7998-7431
authors.initials: L
authors.lastname: Andronis
authors.affiliation: Health Economics Unit, Public Health Building, University of Birmingham, Birmingham, B15 2TT, UK.
authors.forename: Philip
authors.initials: P
authors.lastname: Kinghorn
authors.affiliation: Health Economics Unit, Public Health Building, University of Birmingham, Birmingham, B15 2TT, UK.
authors.forename: Suyin
authors.initials: S
authors.lastname: Qiao
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.|International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.|Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.
authors.forename: David G T
authors.initials: DG
authors.lastname: Whitehurst
authors.affiliation: Gloucestershire Hospitals National Health Service Foundation Trust, Gloucester, UK.
authors.forename: Susie
authors.initials: S
authors.lastname: Durrell
authors.affiliation: Health Economics Unit, Public Health Building, University of Birmingham, Birmingham, B15 2TT, UK.
authors.forename: Hugh
authors.initials: H
authors.lastname: McLeod
mesh_terms: D003362:Cost-Benefit Analysis; D005081:Exercise Therapy / Q000191:economics; D017048:Health Care Costs; D006801:Humans; D017116:Low Back Pain / Q000191:economics* / Q000628:therapy; D010353:Patient Education as Topic / Q000191:economics; D026741:Physical Therapy Modalities / Q000191:economics