Cost-effectiveness of recommended interventions for managing low back pain: A systematic review
9 affiliations
- 1Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- 2Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- 3Warwick Medical School, University of Warwick, Coventry, United Kingdom
- 4University Hospitals of Coventry and Warwickshire, Coventry, United Kingdom
- 5The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- 6Sydney Musculoskeletal Research Centre, Kolling Institute, The University of Sydney, Sydney, New South Wales, Australia
- 7Charles Perkins Centre Musculoskeletal Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- 8Department of Rheumatology, Royal North Shore Hospital, St Leonards, NSW, Australia
- 9Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
Abstract
Background: Low back pain is the leading cause of disability worldwide. Although numerous treatment approaches are recommended by international clinical guidelines, there is still limited understanding of which interventions provide the best value for money. We aimed to critically appraise and summarise the evidence on the cost-effectiveness and costs of interventions endorsed in recent guidelines to manage low back pain (LBP), compared to usual care. Methods and findings: We searched 10 electronic databases (e.g., MEDLINE (OvidSP), EMBASE (OvidSP), PsycINFO (OvidSP)) from inception to 9th of February 2026 for cost-effectiveness studies of guideline-recommended treatments to manage non-specific LBP. The primary outcome was cost/quality-adjusted life year (QALY), which was converted to 2024 Great British Pound values, tabulated and summarised qualitatively. Secondary outcomes were direct costs (total, interventional, health service use, community services and out-of-pocket costs) and indirect costs (e.g., lost wages, lost productivity, absenteeism). We assessed methodological quality using the Consensus Health Economics Criteria (CHEC) checklist for within-trial economic evaluations or the Philips checklist for modelling studies. Our review included 20 studies (17 within-trial economic evaluations and three modelling studies), published between 2005 and 2026. Half (n = 10) focussed on chronic LBP (>3-month duration), and eight included mixed populations (i.e., acute, subacute and chronic). All studies were of non-pharmacological, non-surgical interventions, both single-modality and multimodal interventions (e.g., exercise plus spinal manipulation; diet plus physical activity). Most interventions are cost-effective at a willingness-to-pay threshold of £20,000. Moreover, interventions aiming to reduce fear and stress or support self-management in people with chronic LBP, as well as clinician-delivered interventions including yoga, acupuncture, cognitive therapy and self-management support are potentially cost-saving from the healthcare, societal and payer’s perspectives, as they are both more effective and less costly than usual care (e.g., first contact management, including advice and medication). All of the evidence is derived from high-income countries, and from a considerable heterogenous body of literature. Evidence on cost-effective treatments in low- and middle-income countries remains limited. Conclusions: Non-pharmacological, non-surgical interventions that include education, psychological support, acupuncture and exercise seem to be cost-effective for managing LBP, compared to usual care. Improved access to and implementation of these effective treatments is urgently needed so more people can benefit from them in routine care. Registration: The review was registered on PROSPERO (https://www.crd.york.ac.uk; CRD42024510270). Why was this study done?: What did the researchers do and find?: What do these findings mean?: In a systematic review of studies on low back pain interventions, Stephanie Mathieson and colleagues assess the cost-effectiveness of guideline-endorsed recommendations of non-surgical and non-pharmacological interventions.
Related
- Community-based interventions for managing frailty among people experiencing homelessness: a systematic review
- Effectiveness of Discrete Strategies and Implementation Bundles for Improving Clinician Prescription of Clinical Practice Guideline–Recommended Medications for Atherosclerotic Occlusive Disease: A Systematic Review and Meta‐Analysis
- Effectiveness of dynamic neuromuscular stabilization-based interventions for nonspecific low back pain: a systematic review and meta-analysis
- Comparative effectiveness of exercise and self-management interventions delivered through different modes of digital support on pain and patient-reported physical function in people with knee osteoarthritis: a systematic review and network meta-analysis of randomised controlled trials
- Effectiveness of green health prescribing and nature-based interventions in primary care and community settings for older adults: a systematic review of health, wellbeing and social outcomes
BibTeX
@article{mathieson2026costeffectiveness,
title = {{Cost-effectiveness of recommended interventions for managing low back pain: A systematic review}},
author = {Stephanie Mathieson and Martin Underwood and Muhammad Ibrahim and Zhilin Hua and Zhaohua Zhu and Paulo H. Ferreira and Hema Mistry and Emily R. Atkins and Jocelyn L. Bowden and Jillian P. Eyles and Andrew M. Briggs and David J. Hunter and Manuela L. Ferreira},
journal = {PLOS Medicine},
year = {2026},
month = oct,
doi = {10.1371/journal.pmed.1005273},
url = {https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005273},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Cost-effectiveness of recommended interventions for managing low back pain: A systematic review
AU - Stephanie Mathieson
AU - Martin Underwood
AU - Muhammad Ibrahim
AU - Zhilin Hua
AU - Zhaohua Zhu
AU - Paulo H. Ferreira
AU - Hema Mistry
AU - Emily R. Atkins
AU - Jocelyn L. Bowden
AU - Jillian P. Eyles
AU - Andrew M. Briggs
AU - David J. Hunter
AU - Manuela L. Ferreira
PY - 2026
DA - 2026/10/27
JO - PLOS Medicine
DO - 10.1371/journal.pmed.1005273
UR - https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005273
AB - Background: Low back pain is the leading cause of disability worldwide. Although numerous treatment approaches are recommended by international clinical guidelines, there is still limited understanding of which interventions provide the best value for money. We aimed to critically appraise and summarise the evidence on the cost-effectiveness and costs of interventions endorsed in recent guidelines to manage low back pain (LBP), compared to usual care. Methods and findings: We searched 10 electronic databases (e.g., MEDLINE (OvidSP), EMBASE (OvidSP), PsycINFO (OvidSP)) from inception to 9th of February 2026 for cost-effectiveness studies of guideline-recommended treatments to manage non-specific LBP. The primary outcome was cost/quality-adjusted life year (QALY), which was converted to 2024 Great British Pound values, tabulated and summarised qualitatively. Secondary outcomes were direct costs (total, interventional, health service use, community services and out-of-pocket costs) and indirect costs (e.g., lost wages, lost productivity, absenteeism). We assessed methodological quality using the Consensus Health Economics Criteria (CHEC) checklist for within-trial economic evaluations or the Philips checklist for modelling studies. Our review included 20 studies (17 within-trial economic evaluations and three modelling studies), published between 2005 and 2026. Half (n = 10) focussed on chronic LBP (>3-month duration), and eight included mixed populations (i.e., acute, subacute and chronic). All studies were of non-pharmacological, non-surgical interventions, both single-modality and multimodal interventions (e.g., exercise plus spinal manipulation; diet plus physical activity). Most interventions are cost-effective at a willingness-to-pay threshold of £20,000. Moreover, interventions aiming to reduce fear and stress or support self-management in people with chronic LBP, as well as clinician-delivered interventions including yoga, acupuncture, cognitive therapy and self-management support are potentially cost-saving from the healthcare, societal and payer’s perspectives, as they are both more effective and less costly than usual care (e.g., first contact management, including advice and medication). All of the evidence is derived from high-income countries, and from a considerable heterogenous body of literature. Evidence on cost-effective treatments in low- and middle-income countries remains limited. Conclusions: Non-pharmacological, non-surgical interventions that include education, psychological support, acupuncture and exercise seem to be cost-effective for managing LBP, compared to usual care. Improved access to and implementation of these effective treatments is urgently needed so more people can benefit from them in routine care. Registration: The review was registered on PROSPERO (https://www.crd.york.ac.uk; CRD42024510270). Why was this study done?: What did the researchers do and find?: What do these findings mean?: In a systematic review of studies on low back pain interventions, Stephanie Mathieson and colleagues assess the cost-effectiveness of guideline-endorsed recommendations of non-surgical and non-pharmacological interventions.
SN - 1549-1676
SN - 1549-1277
ER -