Objective To investigate the cost-effectiveness of exercise therapy in the treatment of patients with non-specific neck pain and low back pain.
Design Systematic review of economic evaluations.
Data sources The search was performed in 5 clinical and 3 economic electronic databases.
Eligibility criteria for selecting studies We included economic evaluations performed alongside randomised controlled trials. Differences in costs and effects were pooled in a meta-analysis, if possible, and incremental cost-utility ratios (ICUR) were descriptively analysed.
Results Twenty-two studies were included. On average, exercise therapy was associated with lower costs and larger effects for quality-adjusted life-year (QALY) in comparison with usual care for subacute and chronic low back pain from a healthcare perspective (based on ICUR). Exercise therapy had similar costs and effect for QALY in comparison with other interventions for neck pain from a societal perspective, and subacute and chronic low back pain from a healthcare perspective. There was limited or inconsistent evidence on the cost-effectiveness of exercise therapy compared with usual care for neck pain and acute low back pain, other interventions for acute low back pain and different types of exercise therapy for neck pain and low back pain.
Conclusions Exercise therapy seems to be cost-effective compared with usual care for subacute and chronic low back pain. Exercise therapy was not (more) cost-effective compared with other interventions for neck pain and low back pain. The cost-utility estimates are rather uncertain, indicating that more economic evaluations are needed.
Registration PROSPERO, CRD42017059025.
- systematic review
- lower back
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Contributors GCM drafted the manuscript and conducted meta-analyses. GCM, MvT and JvD screened titles, abstracts and full paper for inclusion. GCM, MvT and JvD were involved in data extraction. GCM, MvT and CL conducted the assessment of the risk of bias and conducted meta-analyses. All authors contributed with research question, critically reviewed the manuscript and approved the manuscript prior to submission.
Funding GCM had her PhD scholarship supported by São Paulo Research Foundation (FAPESP (process: 2013/26321-8 and 2016/07915-2)). CL was supported by a fellowship from the National Health and Medical Research Council, Australia.
Competing interests None declared.
Patient consent Not required.
Provenance and peer review Not commissioned; externally peer reviewed.