United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: cost effectiveness of physical treatments for back pain in primary care

Russell, Ian and Underwood, Martin and Brealey, Stephen and Burton, Kim and Coulton, Simon and Farrin, Amanda and Garratt, Andrew and Harvey, Emma and Letley, Louise and Manca, Andrea and Martin, Jeannett and Klaber Moffett, Jennifer and Morton, Veronica and Torgerson, David J. and Vickers, Madge and Whyte, Ken and Williams, Melanie (2004) United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: cost effectiveness of physical treatments for back pain in primary care. BMJ, 329 (7479). p. 1381. (The full text of this publication is not available from this repository)

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Official URL
http://dx.doi.org/10.1136/bmj.38282.607859

Abstract

Objective To assess the cost effectiveness of adding spinal manipulation, exercise classes, or manipulation followed by exercise ("combined treatment") to "best care" in general practice for patients consulting with low back pain. Design Stochastic cost utility analysis alongside pragmatic randomised trial with factorial design. Setting 181 general practices and 63 community settings for physical treatments around 14 centres across the United Kingdom. Participants 1287 (96%) of 1334 trial participants. Main outcome measures Healthcare costs, quality adjusted life years (QALYs), and cost per QALY over 12 months. Results Over one year, mean treatment costs relative to "best care" were {pound}195 ($360; {euro}279; 95% credibility interval {pound}85 to {pound}308) for manipulation, {pound}140 ({pound}3 to {pound}278) for exercise, and {pound}125 ({pound}21 to {pound}228) for combined treatment. All three active treatments increased participants' average QALYs compared with best care alone. Each extra QALY that combined treatment yielded relative to best care cost {pound}3800; in economic terms it had an "incremental cost effectiveness ratio" of {pound}3800. Manipulation alone had a ratio of {pound}8700 relative to combined treatment. If the NHS was prepared to pay at least {pound}10 000 for each extra QALY (lower than previous recommendations in the United Kingdom), manipulation alone would probably be the best strategy. If manipulation was not available, exercise would have an incremental cost effectiveness ratio of {pound}8300 relative to best care. Conclusions Spinal manipulation is a cost effective addition to "best care" for back pain in general practice. Manipulation alone probably gives better value for money than manipulation followed by exercise.

Item Type: Article
Subjects: H Social Sciences
R Medicine
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
R Medicine > RA Public aspects of medicine
Divisions: Faculties > Social Sciences > School of Social Policy Sociology and Social Research > Centre for Health Services Studies
Depositing User: Helen McGregor
Date Deposited: 25 Oct 2010 12:47
Last Modified: 18 Jun 2014 08:46
Resource URI: http://kar.kent.ac.uk/id/eprint/25768 (The current URI for this page, for reference purposes)
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