International Journal of Technology Assessment in Health Care


Randomized trial of a brief physiotherapy intervention compared with usual physiotherapy for neck pain patients: Cost-effectiveness analysis

Andrea Manca a1, David M. Epstein a1, David J. Torgerson a1, Jennifer A. Klaber Moffett a2, Simon Coulton a1, Amanda J. Farrin a3, Seokyung Hahn a4, David A. Jackson a2 and Stewart J. Richmond a2
a1 University of York
a2 University of Hull
a3 University of Leeds
a4 Seoul National University College of Medicine


Objectives: To assess the cost-effectiveness of brief physiotherapy intervention versus usual physiotherapy management in patients with neck pain of musculoskeletal origin in the community setting.

Methods: A cost-effectiveness analysis was conducted alongside a multicenter pragmatic randomized controlled clinical trial. Individuals 18 years of age and older with neck pain of more than 2 weeks were recruited from physiotherapy departments with referrals from general practitioners (GPs) in the East Yorkshire and North Lincolnshire regions in the United Kingdom. A total of 139 patients were allocated to the brief intervention, and 129 to the usual physiotherapy. Resource use data were prospectively collected on the number of physiotherapy sessions, hospital stay, specialist, and GP visits. Quality-adjusted life years (QALYs) were estimated using EQ-5D data collected at baseline, 3 and 12 months from the start of the treatment. The economic evaluation was conducted from the U.K. National Health System perspective.

Results: On average, brief intervention produced lower costs (£−68; 95 percent confidence interval [CI], £−103 to £−35) and marginally lower QALYs (−0.001; 95 percent CI, −0.030 to 0.028) compared with usual physiotherapy, resulting in an incremental cost per QALY of £68,000 for usual physiotherapy. These results are sensitive to patients' treatment preferences.

Conclusions: Usual physiotherapy may not be good value for money for the average individual in this trial but could be a cost-effective strategy for those who are indifferent toward which treatment they receive.

Key Words: Neck-pain physical therapy; Randomized controlled trial; Economics; Quality of life; Cost-effectiveness analysis.