Cost-effectiveness of recommended interventions for managing low back pain: A systematic review.
Stephanie Mathieson, Martin Underwood, Muhammad Ibrahim et al.
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In 30 seconds
This systematic review assessed the cost-effectiveness of guideline-recommended interventions for non-specific low back pain compared with usual care. It included 20 studies published between 2005 and 2026: 17 within-trial economic evaluations and three modelling studies. The evidence covered non-pharmacological, non-surgical approaches, with half the studies focused on chronic low back pain. Most interventions were cost-effective at a willingness-to-pay threshold of £20,000. Some approaches, including psychological support and self-management interventions, were reported as potentially both more effective and less costly than usual care.
Key findings
- The review included 20 studies: 17 within-trial economic evaluations and three modelling studies.
- Most interventions were cost-effective at a willingness-to-pay threshold of £20,000.
- Interventions targeting fear, stress or self-management in chronic low back pain were potentially more effective and less costly than usual care.
- All included evidence came from high-income countries; evidence from low- and middle-income countries was limited.
Why it matters
Economic evidence can help inform decisions about which low back pain services may offer value alongside clinical benefit. The review suggests that several non-drug, non-surgical options may be cost-effective, and some may reduce costs while improving outcomes. However, the findings draw on heterogeneous studies and do not establish that every intervention will deliver similar value across health systems.
What to keep in mind
The evidence was heterogeneous and came exclusively from high-income countries, limiting its applicability to low- and middle-income settings.