Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain: economic evaluation

Abstract

Objective An economic evaluation of therapeutic massage, exercise, and lessons in the Alexander technique for treating persistent back pain.Design Cost consequences study and cost effectiveness analysis at 12 month follow-up of a factorial randomised controlled trial.Participants 579 patients with chronic or recurrent low back pain recruited from primary care.Interventions Normal care (control), massage, and six or 24 lessons in the Alexander technique. Half of each group were randomised to a prescription for exercise from a doctor plus behavioural counselling from a nurse.Main outcome measures Costs to the NHS and to participants. Comparison of costs with Roland-Morris disability score (number of activities impaired by pain), days in pain, and quality adjusted life years (QALYs). Comparison of NHS costs with QALY gain, using incremental cost effectiveness ratios and cost effectiveness acceptability curves.Results Intervention costs ranged from £30 for exercise prescription to £596 for 24 lessons in Alexander technique plus exercise. Cost of health services ranged from £50 for 24 lessons in Alexander technique to £124 for exercise. Incremental cost effectiveness analysis of single therapies showed that exercise offered best value (£61 per point on disability score, £9 per additional pain-free day, £2847 per QALY gain). For two-stage therapy, six lessons in Alexander technique combined with exercise was the best value (additional £64 per point on disability score, £43 per additional pain-free day, £5332 per QALY gain).Conclusions An exercise prescription and six lessons in Alexander technique alone were both more than 85% likely to be cost effective at values above £20 000 per QALY, but the Alexander technique performed better than exercise on the full range of outcomes. A combination of six lessons in Alexander technique lessons followed by exercise was the most effective and cost effective option.

Are physical activity interventions in primary care and the community cost-effective? A systematic review of the evidence

“…Furthermore, some studies included funder costs only, 17,[21][22][23][24][25][26] while others presented societal perspectives that also included costs to the participant. 11,[18][19][20]27 Consequently, there was a wide variation in costs per QALY gained between the studies. For example, the study of Gusi et al, involving a walking programme for older women who were overweight or had moderate depression, had the lowest cost per QALY of €348.…”

“…When considering interventions for specific disease-based populations, the exercise prescription given by the GP and exercise counselling by the practice nurse for people with chronic or recurrent low back pain 20 was more cost-effective (€4577 per QALY) than the water-based exercise intervention for older participants with osteoarthritis of the hip and/or knee (€9160 per QALY). 18 A weekly exercise class for sedentary people aged 65 years and older 24 was more cost-effective (€19 425 per QALY) than both the supervised gym-based exercise classes and the instructor-led walking programme for sedentary 40-74 year olds (€35 665 and €86 877 per QALY).…”

Cost-effectiveness of guideline-endorsed treatments for low back pain: a systematic review

“…Ratcliffe et al [37] showed that acupuncture had a low ICER compared to GP care from the healthcare sector perspective (4,241 in 2002 to 2003 GBP per QALY gained, 95% CI = 191-28,026), and was dominant over GP care from the societal perspective. Hollinghurst et al [34] investigated the cost-effectiveness of massage over a 1-year period. Compared to GP care, massage incurred higher costs from the healthcare sector's perspective and was less effective (QALY gained = -34,473 in 2005 GBP).…”

“…The only exceptions were two studies which recruited participants of a mixed duration of symptoms [30,32] two which did not specify the duration of symptoms [20], and one which recruited participants sick listed for less than 2 weeks due to LBP [31]. Most studies were conducted in the UK [32][33][34][35][36][37][38][39][40] or other European countries [21-24, 26-29, 31, 41-45]; three studies were conducted in the United States [20,30] and two in Canada [25,46]. All studies were published in English.…”

“…These interventions were compared to conventional physiotherapy [29,32,33,43], GP care [25,28,30,35], spinal surgery [29] or walking [39], or as an additional treatment to advice [23,24,26], GP care [34,36,40] or inpatient rehabilitation [44]. Regardless of the comparisons and the perspectives adopted, all but two studies [30,32] found that these interventions were cost-effective compared to the treatment alternatives (Table 3).…”