Current guidelines advocate for early intervention addressing psychosocial factors linked to long-term disability in acute low back pain cases. In 2007, Whitehurst, et. al., conducted study which aimed to evaluate the cost utility and effectiveness of a brief pain management program (BPM) targeting psychosocial factors compared to physical therapy (PT) for patients with low back pain in primary care, lasting less than 12 weeks.

In a randomized clinical trial, 402 patients were assigned either to BPM or PT. The study adopted a healthcare perspective, analyzing direct healthcare costs associated with low back pain. Quality-adjusted life years (QALYs) and 12-month change scores on the Roland and Morris disability questionnaire were the outcome measures. Data on resource utilization related to back pain were collected at a 12-month follow-up. Cost-effectiveness was assessed through incremental ratios, and uncertainty was evaluated using cost-effectiveness planes and acceptability curves.

No statistically significant differences were observed in mean healthcare costs or outcomes between the two treatments. PT showed slightly higher effectiveness at 12 months, albeit with increased healthcare costs (BPM £142, PT £195). The incremental cost-per-QALY ratio was £2,362. If the UK National Health Service were willing to pay £10,000 per additional QALY, there is only a 17% probability that BPM provides the best value for money.

Physical therapy emerges as a cost-effective primary care strategy for managing low back pain. Nevertheless, the absence of a clinically superior treatment program suggests that BPM could serve as an alternative primary care approach, delivered in fewer sessions, with consideration given to patient and physician preferences.

Reference: Whitehurst, D. G. T., Lewis, M., Yao, G. L., Bryan, S., Raftery, J. P., Mullis, R., & Hay, E. M. (2007). A brief pain management program compared with physical therapy for low back pain: results from an economic analysis alongside a randomized clinical trial. Arthritis Care & Research, 57(3), 466-473.