Table 2.

One-Year Model Results for Each Nonpharmacologic Therapy Compared to Usual Care from the Societal and Payer Perspectives and Assuming a ‘Typical’* Mix of Chronic Low Back Pain Patients at Baseline

Treatment CostsOther Healthcare Costs (Societal)Productivity CostsTotal Costs (Societal)Total Costs (Payer)†QALYs
Active Trunk Exercise (1)$1077−$898−$419−$241 (−1,060, 934)$188 (−433, 993)0.033 (0.00, 0.06)
Active Trunk Exercise (2)$1073−$536−$364$173 (−460, 1,042)$530 (103, 1,073)0.024 (0.00, 0.04)
CBT Educational Program$77−$286−$101−$310 (−1,040, 517)−$197 (−692, 341)0.010 (−0.01, 0.03)
Chiropractic Care$199−$252−$88−$142 (−1,655, 1,362)−$40 (−1,012, 935)0.008 (−0.03, 0.04)
Exercise$141−$284−$211−$354 (−696, 46)−$146 (−369, 96)0.013 (0.00, 0.02)
Exercise + Manipulation$509−$410−$235−$136 (−459, 257)$117 (−84, 376)0.016 (0.01, 0.03)
Flexion Distraction (1)$504−$906−$416−$818 (−1,557, 292)−$389 (−929, 289)0.033 (0.01, 0.05)
Flexion Distraction (2)$501−$544−$360−$403 (−941, 230)−$47 (−415, 358)0.024 (0.01, 0.04)
Individualized Acupuncture$480−$717−$355−$592 (−1,430, 367)−$202 (−708, 496)0.025 (0.00, 0.05)
Manipulation$480−$362−$225−$106 (−429, 282)$120 (−100, 357)0.015 (0.01, 0.02)
Multidisciplinary Program$260−$449−$181−$369 (−1,168, 563)−$172 (−699, 450)0.015 (−0.01, 0.04)
Physical Therapy$406−$439−$190−$223 (−1,777, 1,658)−$13 (−1,108, 1,130)0.015 (−0.03, 0.05)
Relaxation Massage$459−$592−$359−$491 (−1195, 431)−$116 (−566, 529)0.023 (0.00, 0.04)
Spinal Manipulation (3)$520−$13$6$513 (91, 888)$457 (190, 726)0.004 (−0.01, 0.02)
Spinal Manipulation (4)$520−$472−$85−$37 (−774, 689)$47 (−382, 514)0.016 (0.00, 0.03)
Standardized Acupuncture$487−$637−$252−$402 (−1,208, 447)−$117 (−614, 481)0.021 (0.00, 0.04)
Structural Massage$448−$406−$286−$244 (−978, 722)$54 (−447, 658)0.017 (−0.01, 0.04)
TCM Acupuncture$459−$139−$19$302 (−304, 875)$328 (−83, 691)0.004 (−0.01, 0.02)
Therapeutic Massage$437−$376−$258−$197 (−649, 296)$69 (−202, 393)0.015 (0.00, 0.03)
Yoga$385−$1626−$531−$1,773 (−2,730, −372)−$1,136 (−1,784, −151)0.048 (0.02, 0.07)

CBT = Cognitive behavioral therapy; QALY = Quality-adjusted Life-Year; TCM = Traditional Chinese acupuncture

*Typical mix of chronic low-back pain patients was assumed to be 25% low-impact chronic pain, 35% moderate-impact chronic pain, and 40% high-impact chronic pain. The proportions roughly correspond to the average baseline proportions seen in the studies included in the model.

†The payer perspective used an estimate of other healthcare costs that excluded patient out-of-pocket payments and assumed that the payer covered all treatment costs. Note that the assumption of full coverage for treatment costs is in contrast with current payer policies (see Heyward et al, JAMA Network Open. 2018;1(6):e183044-e). Thus, these payer perspective costs are likely overstated.

Each intervention is compared to the usual care arm of their study with the exception of the two studies (three interventions) that did not include usual care arms. For these we assigned two of the other US-based usual care arms based on the closest matches in terms of data collection schedules. The usual care arms assigned for each are: (1) Usual care (Sherman); (2) Usual care (Moore); (3) Self-care education (Cherkin 2001); (4) Usual care (Cherkin 2009).