Introduction
Methods
Search strategy
Study selection
Risk of bias assessment
Data extraction
Comparisons
Results
Study selection
Study characteristics
Study ID, type and perspective | Design | Groups | Effect differences (95 % CI) | Cost differences (95 % CI) | Incremental cost-effectiveness ratio |
---|---|---|---|---|---|
Korthals-de Bos et al. [14] Type: CEA/CUA Country: The Netherlands Perspective: societal Index year: not specified | Randomised controlled trial with a 12-month follow-up period. 183 patients with at least 2 weeks of non-specific neck pain. | (1) Manual therapy (MT): mobilisation and manipulation (one session per week up to six sessions) (2) Physiotherapy (PT): exercise, including relaxation exercises, stretching and functional exercises (30 min twice a week, up to 12 sessions) (3) General practitioner care (GP): standardised GP care + educational booklet (one session with optional fortnightly follow ups) |
Perceived recovery, % (6-point scale much worse –completely recovered)
MT vs. PT: 9.0 (−7.9 to 25.8) MT vs. GP: 15.4 (−1.3 to 32.1) PT vs. GP: 6.5 (−10.9 to 23.8)
Pain intensity (0–10 scale)
MT vs. PT: 1.2 (0.1–2.1) MT vs. GP: 0.1 (−0.8 to 1.1) PT vs. GP: −1.0 (−2.0 to 0.002)
Disability (Neck Disability Index 10 item 5-point scale)
MT vs. PT: 0.9 (−1.9 to 3.6) MT vs. GP: −1.4 (−4.1 to 1.3) PT vs. GP: −2.2 (−5.0 to 0.5)
QALY (EQ-5D)
MT vs. PT: 0.03 (−0.04 to 0.09) MT vs. GP: 0.05 (−0.01 to 0.11) PT vs. GP: 0.02 (−0.04 to 0.09) | MT vs. PT: €−850 (−2,258 to −239) MT vs. GP: €−932 (−1,932 to −283) PT vs. GP: €−82 (−1,063 to 1,446) |
Perceived recovery
MT vs. PT: €−9,488 MT vs. GP: €−6,041 PT vs. GP: €−1,265
Pain intensity
MT vs. PT: €−757 MT vs. GP: €−6,652 PT vs. GP: €83
Disability
MT vs. PT: €−967 MT vs. GP: €682 PT vs. GP: €36
QALY
MT vs. PT: €−31,144 MT vs. GP: €−15,505 PT vs. GP: €2,688 |
Manca et al. [16] Type: CEA/CUA Country: United Kingdom Perspective: healthcare and societal Index year: 2001–2002 | Randomised controlled trial with a 12-month follow-up period. 268 patients with at least 2 weeks neck pain. | (1) Brief intervention (BI): improve communication skills, de-medicalise the problem, and learn the principles of cognitive behavioural therapy (up to three sessions) (2) Usual PT (advice, MT, electrotherapy, acupuncture) |
QALY (EQ-5D)
BI vs. PT: −0.001 (−0.0030 to 0.028)
Pain (Neck Pain Questionnaire, 0–36 points)
BI vs. PT: 0.686 (−0.255 to 1.665) |
Healthcare costs
BI vs. PT: €−78 (−117 to −40)
Societal costs
BI vs. PT: €−117 (−331 to 99) |
Healthcare perspective
QALY
€78,000
Pain
€113
Societal perspective
QALY
€117,000
Pain
€171 |
Willich et al. (2006) [17] Type: CEA/CUA Country: Germany Perspective: societal Index year: not specified | Randomised controlled trial with a 3-month follow-up period. 3,451 patients with chronic neck pain. | (1) Immediate acupuncture (10–15 sessions) (2) Delayed acupuncture after 3 months |
QALY (SF 6D)
Acupuncture vs. delayed acupuncture 0.024 (SE 0.004), p < 0.001 | Acupuncture vs. delayed acupuncture € 293.91 (SE 51.79) |
QALY
€12,469 |
Lewis et al. [15] Type: CEA/CUA Country: United Kingdom Perspective: healthcare and societal Index year: 2003–2004 | Randomised controlled trial with a 6-month follow-up. 350 patients with non-specific neck pain. | Interventions delivered over 6 weeks, with a maximum of eight 20-min sessions. (1) Advice and exercise: Individualised education, advice about coping with neck pain and a home exercise program (2) Advice and exercise + MT: passive and active assisted movements, mobilisations, and manipulations (3) Advice and exercise + pulse shortwave diathermy |
Neck pain and disability (Neck Pain Questionnaire 0–100 points)
Advice and exercise + MT vs. advice and exercise: −1.0 (−5.1 to 3.1) Advice and exercise + PSD vs. advice and exercise: −1.7 (−5.4 to 2.4)
QALY (EQ-5D)
Advice and exercise + MT vs. advice and exercise: 0.002 (−0.023 to 0.026) Advice and exercise + PSD vs. advice and exercise: 0.001 (−0.023 to 0.026) |
Healthcare costs
Advice and exercise + MT vs. advice and exercise: €6.8 (−39.03 to 44.28) Advice and exercise + PSD vs. advice and exercise: €20.5 (−22.94 to 55.21)
Societal costs
Advice and exercise + MT vs. advice and exercise: €−87.03 (−512.52 to 584.28) Advice and exercise + PSD vs. advice and exercise: €8.65 (−372.18 to 380.38) |
Healthcare perspective
Neck pain and disability
Advice and exercise + MT vs. advice and exercise: €−6.80 Advice and exercise + PSD vs. advice and exercise: €−12.06
QALY
Advice and exercise + MT vs. advice and exercise: €3,402 Advice and exercise + PSD vs. advice and exercise: €20,497
Societal perspective
Neck pain and disability
Advice and exercise + MT vs. advice and exercise: €87.03 Advice and exercise + PSD vs. advice and exercise: €−5.08
QALY
Advice and exercise + MT vs. advice and exercise: €−43,513 Advice and exercise + PSD vs. advice and exercise: €8,652 |
Bosmans et al. [13] Type: CEA/CUA Country: The Netherlands Perspective: societal Index year: 2004 | Randomised controlled trial with a 12-month follow-up period. 180 patients with sub acute (4–12 weeks) non-specific neck pain. | (1) Manual therapy: Manipulation and mobilisation (up to six 30 to 45-min sessions in 6 weeks) (2) Behavioural graded activity programme (BGA) |
Global perceived recovery (7-point scale completely recovered to worse than ever)
BGA vs. MT: 0.02 (−0.12 to 0.16)
Pain (0–10 scale)
BGA vs. MT: −2.4 (−4.5 to −0.22)
Disability (Neck Disability Index 10-items 5-point scale)
BGA vs. MT: −0.88 (−1.7 to −0.02)
QALY (SF-6D)
BGA vs. MT: −0.02 (−0.06 to 0.02) | BGA vs. MT €260 (−107 to 825) |
Global perceived recovery
€13,083
Pain
€296
Disability
€−296
QALY
€−13,000 |
Risk of bias
Criterion | Korthals-de Bos et al. [14] | Manca et al. [16] | Willich et al. [17] | Lewis et al. [15] | Bosmans et al. [13] |
---|---|---|---|---|---|
Study population | + | + | + | – | + |
Competing alternatives | + | + | + | + | + |
Research question | + | + | + | + | + |
Study design | + | + | + | + | + |
Time horizon | + | + | – | – | + |
Perspective | + | + | + | + | + |
Relevant costs | + | + | – | + | + |
Physical units | + | + | – | + | + |
Appropriate valuation | + | + | – | + | + |
Relevant outcomes | + | + | + | + | + |
Outcomes appropriately measured | + | + | + | + | + |
Appropriate outcome valuation | + | + | + | + | + |
Incremental analyses | + | + | + | + | + |
Discounting | N/A | N/A | N/A | N/A | N/A |
Sensitivity analyses | – | – | + | + | – |
Adequate conclusions | + | + | + | + | + |
Generalisability | – | + | + | + | + |
Conflict interests | + | + | + | + | + |
Ethics discussed | + | + | + | + | + |