Cost Effectiveness


“The total costs in the manual therapy group were around one third of the costs in the physiotherapy and general practitioner care groups. Total direct, indirect, and total costs were statistically significantly lower in the manual therapy group than in the physiotherapy and general practitioner care groups.”


Neck pain, though not typically life-threatening, is a common cause of disability and absence from work and can be very costly to treat. Korthals-de Bos et al. (2003) tracked treatment outcomes and direct and indirect costs for 183 patients over a one year period. Participants were randomly assigned to one of three treatment types: manual therapy (spinal mobilization), physiotherapy (exercise), or general practitioner care (counseling, education, medication). At 3, 7, 13, 26, and 52 weeks, participants reported their perceived recovery, pain levels, functional disability, healthcare utilization, costs of treatment, and indirect costs (e.g. lost pay due to missed work). All three treatment types were found to be effective, but manual therapy resulted in the lowest costs and fastest rate of recovery. Those in the manual therapy group also missed the fewest days of work. Manual therapy was therefore determined to be the most cost-effective treatment for neck pain.

Korthals-de Bos, I. B. C., Hoving, J. L., van Tulder, M. W., Rutten-van Molken, M. P. M. H., Ader, H. J., de Vet, H. C. W.,…& Bouter, L. M. (2003). Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: Economic evaluation alongside a randomized controlled trial. British Medical Journal, 326(7395), 911. doi: 10.1136/bmj.326.7395.911