Table 5.
Cost-effectiveness results
| Mean Costs (SD)* |
Δ Costs (95% CI)† |
Mean Outcome (SD)* |
Δ Outcomes (95% CI)† |
ICER (95% CI)† |
|
|---|---|---|---|---|---|
| Societal Perspective | |||||
| Pain Reduction | |||||
|
| |||||
| SMT + HEA | $2,198 ($2,040) | - | 2.4 (2.1) | - | Reference |
| HEA | $2,305 ($1,634) | - | 1.6 (1.9) | - | Dominated‡ |
| SRE + HEA | $4,129 ($1,438) | - | 1.8 (1.9) | - | Dominated‡ |
|
| |||||
| Disability Reduction | |||||
|
| |||||
| SMT + HEA | $2,198 ($2,040) | - | 7.4 (9.9) | - | Reference |
| HEA | $2,305 ($1,634) | - | 6.1 (8.8) | - | Dominated‡ |
| SRE + HEA | $4,129 ($1,438) | - | 5.6 (8.5) | - | Dominated‡ |
|
| |||||
| QALYs Gained (SF-6D) | |||||
|
| |||||
| SMT + HEA | $2,198 ($2,040) | - | 0.039 (0.106) | - | Reference |
| HEA | $2,305 ($1,634) | - | 0.031 (0.101) | - | Dominated‡ |
| SRE + HEA | $4,129 ($1,438) | - | 0.030 (0.084) | - | Dominated‡ |
|
| |||||
| Sensitivity Analyses | |||||
| QALYs Gained (EQ-5D) | |||||
|
| |||||
| SMT + HEA | $2,198 ($2,040) | - | 0.027 (0.110) | - | Reference |
| HEA | $2,305 ($1,634) | - | 0.020 (0.090) | - | Dominated‡ |
| SRE + HEA | $4,129 ($1,438) | - | 0.011 (0.090) | - | Dominated‡ |
|
| |||||
| Healthcare Perspective | |||||
| Pain Reduction | |||||
|
| |||||
| HEA | $779 ($281) | - | 1.6 (1.9) | - | Reference |
| SMT + HEA | $1,297 ($1,792) | $515 ($225 to $1,094) | 2.4 (2.1) | 0.57 (0.23 to 0.92) | $895 ($317 to $3,178) ¥ |
| SRE + HEA | $2,556 ($505) | - | 1.8 (1.9) | - | Dominated‡ |
|
| |||||
| Disability Reduction | |||||
|
| |||||
| HEA | $779 ($281) | - | 6.1 (8.8) | - | Reference |
| SMT + HEA | $1,297 ($1,792) | $515 ($225 to $1,094) | 7.4 (9.9) | 1.67 (-0.15 to 3.41) | $308 ($97 to Dominated‡) ¥ |
| SRE + HEA | $2,556 ($505) | - | 5.6 (8.5) | - | Dominated‡ |
|
| |||||
| QALYs Gained (SF6D) | |||||
|
| |||||
| HEA | $779 ($281) | - | 0.031 (0.101) | - | Reference |
| SMT + HEA | $1,297 ($1,792) | $515 ($225 to $1,094) | 0.039 (0.106) | 0.009 (-0.011 to 0.029) | $55,975 ($18,733 to Dominated‡) ¥ |
| SRE + HEA | $2,556 ($505) | - | 0.030 (0.084) | - | Dominated‡ |
*
Unadjusted mean (SD);
†
Adjusted mean (95% bias-corrected bootstrap confidence intervals) from longitudinal model for treatments with higher costs and better outcomes;
‡
Dominated = worse mean outcome and higher mean cost;
¥
ICERs are calculated based on 7 digit accuracy of Δ in costs and outcomes, reported Δ in costs and outcomes were rounded for presentation;
HEA = Home exercise and advice; ICER = Incremental cost-effectiveness ratio; SMT = Spinal manipulation therapy; SRE = Supervised rehabilitative exercise; QALY = Quality-adjusted life year