Cost-effectiveness of non-invasive and non-pharmacological interventions for low back pain: a systematic literature review

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 health care systems and, more broadly, societies. Many interventions to alleviate LBP are available but their cost-effectiveness is unclear.

Objectives
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 NHS 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: (i) combined physical exercise and psychological therapy, (ii) physical exercise therapy only, (iii) information and education and,(iv) 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.