Applied Health Economics and Health Policy

, Volume 15, Issue 2, pp 173–201 | Cite as

Cost-Effectiveness of Non-Invasive and Non-Pharmacological Interventions for Low Back Pain: a Systematic Literature Review

  • Lazaros AndronisEmail author
  • Philip Kinghorn
  • Suyin Qiao
  • David G. T. Whitehurst
  • Susie Durrell
  • Hugh McLeod
Systematic Review



Low back pain (LBP) is a major health problem, having a substantial effect on peoples’ quality of life and placing a significant economic burden on healthcare systems and, more broadly, societies. Many interventions to alleviate LBP are available but their cost effectiveness is unclear.


To identify, document and appraise studies reporting on the cost effectiveness of non-invasive and non-pharmacological treatment options for LBP.


Relevant studies were identified through systematic searches in bibliographic databases (EMBASE, MEDLINE, PsycINFO, Cochrane Library, CINAHL and the National Health Service Economic Evaluation Database), ‘similar article’ searches and reference list scanning. Study selection was carried out by three assessors, independently. Study quality was assessed using the Consensus on Health Economic Criteria checklist. Data were extracted using customized extraction forms.


Thirty-three studies were identified. Study interventions were categorised as: (1) combined physical exercise and psychological therapy, (2) physical exercise therapy only, (3) information and education, and (4) manual therapy. Interventions assessed within each category varied in terms of their components and delivery. In general, combined physical and psychological treatments, information and education interventions, and manual therapies appeared to be cost effective when compared with the study-specific comparators. There is inconsistent evidence around the cost effectiveness of physical exercise programmes as a whole, with yoga, but not group exercise, being cost effective.


The identified evidence suggests that combined physical and psychological treatments, medical yoga, information and education programmes, spinal manipulation and acupuncture are likely to be cost-effective options for LBP.


Economic Evaluation Usual Care Societal Perspective Manual Therapy Spinal Manipulation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Authors’ contribution

LA: Contributed to the study conception and design, data collection, data analysis and interpretation, drafting the article and carrying out critical revisions. PK: Contributed to the study conception and design, data collection, data analysis and interpretation, drafting sections of the article and carrying out critical revisions. SQ: Contributed to data collection, data analysis and interpretation, drafting sections of the article and carrying out critical revisions. DW: Contributed to the study conception and design, data collection, data analysis and interpretation, drafting sections of the article and carrying out critical revisions. SD: Contributed to data analysis and interpretation, and carrying out critical revisions. HM: Contributed to the study conception and design, data collection, data analysis and interpretation, drafting sections of the article and carrying out critical revisions. All authors approved the final version of this manuscript.

Compliance with Ethical Standards


No funding has been received for this study.

Conflicts of interest

LA, PK, SQ, DW, SD and HM have no conflicts of interest to declare.

Supplementary material

40258_2016_268_MOESM1_ESM.docx (26 kb)
Supplementary material 1 (DOCX 26 kb)


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Health Economics Unit, Public Health BuildingUniversity of BirminghamBirminghamUK
  2. 2.Faculty of Health SciencesSimon Fraser UniversityBurnabyCanada
  3. 3.International Collaboration on Repair Discoveries, Faculty of MedicineUniversity of British ColumbiaVancouverCanada
  4. 4.Centre for Clinical Epidemiology and EvaluationVancouver Coastal Health Research InstituteVancouverCanada
  5. 5.Gloucestershire Hospitals National Health Service Foundation TrustGloucesterUK

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