To determine the cost-effectiveness of individualised or stratified physiotherapy for LBP.
A systematic review was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). EMBASE, MEDLINE, Cochrane Library, CINAHL and EconLit databases were searched for economic evaluations performed alongside randomized controlled trials where the intervention used was either stratified or individualised physiotherapy in adults with LBP published up to March 2024. Studies meeting the inclusion criteria were identified and extracted key data by two independent reviewers. Study quality was assessed using the Consensus on Health Economic Criteria (CHEC) checklist and the PEDro scale was used to measure the methodological quality of clinical trials.
The review included 7 studies with an average score of 8/10 on PEDro and a score of 17/19 on CHEC List indicating a high level of quality in the study's economic evaluation. Five studies revealed that individualised/stratified physiotherapy was cost-effective, with either lower costs and additional Quality Adjusted Life Years (QALYs), or an Incremental Cost Effectiveness Ratio below the NICE willingness to pay threshold of between £20,000 and £30,000 per Quality-Adjusted Life Year (QALY). The other two studies were not cost-effective.
This review found stratified or individualised interventions to generally be more cost-effective than comparison treatments.
The review indicates that healthcare systems and policymakers should prioritize the development and implementation of individualised interventions for their demonstrated cost-effectiveness. Further research is needed to assess individualised or stratified treatments, long-term cost-effectiveness, and the feasibility of these approaches in low- and middle-income countries (LMICs).
Low back pain
Physiotherapy
