PAM21: MANUAL THERAPY IS MORE COST-EFFECTIVE THAN PHYSICAL THERAPY AND GP CARE FOR PATIENTS WITH NECK PAIN

Abstract

OBJECTIVES: This paper presents the results of an economic evaluation in conjunction with a randomized controlled trial to evaluate the cost-effectiveness of manual therapy, physical therapy and GP care for patients with neck pain. METHODS: Patients were recruited by 42 general practitioners if they had been suffering from neck pain for at least two weeks. The 183 patients were randomly allocated to manual therapy (spinal mobilization, n = 60), physical therapy (exercise therapy and massage, 59), or GP care (counseling, education and medication, n = 64). Clinical outcomes included perceived recovery, pain intensity, functional disability and quality of life (EuroQol). Direct and indirect costs were measured by means of cost diaries completed by patients during the intervention period and the 52-week follow up. Differences in mean costs between groups were evaluated by applying non-parametric bootstrapping techniques. RESULTS: The total costs of the manual therapy (Euro 447) were approximately one-third of the costs of the physical therapy (Euro 1,297) and GP care (Euro 1,379). These differences were found to be statistically significant when bootstrapping was applied. The cost-effectiveness ratios and the cost-utility ratios showed that manual therapy was dominant (less costly and more effective), compared to physical therapy and GP care. The recovery rates based on perceived recovery after 12 months were 72% for manual therapy, 63% for physical therapy and 56% for GP care. With regard to pain intensity and functional disability, manual therapy was also found to be dominant over time, compared to physical therapy and GP care, for these clinical outcomes, although the differences were small. CONCLUSIONS: This study showed that manual therapy (spinal mobilization) is more effective and less costly than physical therapy and GP care.