Health Technology Assessment & Transfer

European Spine Journal

, Volume 20, Issue 7, pp 1012-1023

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Cost-effectiveness of general practice care for low back pain: a systematic review

  • Chung-Wei Christine LinAffiliated withThe George Institute for Global Health and Sydney Medical School, The University of Sydney Email author 
  • , Marion HaasAffiliated withCentre for Health Economics Research and Evaluation, The University of Technology
  • , Chris G. MaherAffiliated withThe George Institute for Global Health and Sydney Medical School, The University of Sydney
  • , Luciana A. C. MachadoAffiliated withDepartamento de Fisioterapia e Terapia Ocupacional, Universidade Federal de Minas Gerais
  • , Maurits W. van TulderAffiliated withDepartment of Health Sciences, Faculty of Earth and Life Sciences, The EMGO Institute for Health and Care Research, VU University


Care from a general practitioner (GP) is one of the most frequently utilised healthcare services for people with low back pain and only a small proportion of those with low back pain who seek care from a GP are referred to other services. The aim of this systematic review was to evaluate the evidence on cost-effectiveness of GP care in non-specific low back pain. We searched clinical and economic electronic databases, and the reference list of relevant systematic reviews and included studies to June 2010. Economic evaluations conducted alongside randomised controlled trials with at least one GP care arm were eligible for inclusion. Two reviewers independently screened search results and extracted data. Eleven studies were included; the majority of which conducted a cost-effectiveness or cost-utility analysis. Most studies investigated the cost-effectiveness of usual GP care. Adding advice, education and exercise, or exercise and behavioural counselling, to usual GP care was more cost-effective than usual GP care alone. Clinical rehabilitation and/or occupational intervention, and acupuncture were more cost-effective than usual GP care. One study investigated the cost-effectiveness of guideline-based GP care, and found that adding exercise and/or spinal manipulation was more cost-effective than guideline-based GP care alone. In conclusion, GP care alone did not appear to be the most cost-effective treatment option for low back pain. GPs can improve the cost-effectiveness of their treatment by referring their patients for additional services, such as advice and exercise, or by providing the services themselves.


Low back pain Cost-effectiveness analysis Primary health care Systematic review