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Family Practice Advance Access published online on November 5, 2004
Family Practice, doi:10.1093/fampra/cmh612
© 2004 by Oxford University Press
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Received May 27, 2004
Accepted June 17, 2004

Article

Cost-utility analysis of osteopathy in primary care: results from a pragmatic randomized controlled trial

Nefyn H. Williams 1*, Rhiannon T. Edwards 2, Pat Linck 3, Rachel Muntz 2, Richard Hibbs 4, Clare Wilkinson 1, Ian Russell 5, Daphne Russell 5, and Barry Hounsome 2

1 Department of General Practice, University of Wales College of Medicine, Cardiff University, UK
2 Centre for the Economics of Health, Institute of Medical and Social Care Research, University of Wales Bangor, UK
3 Department of General Practice, University of Wales College of Medicine, Cardiff University, UK; Centre for the Economics of Health, Institute of Medical and Social Care Research, University of Wales Bangor, UK
4 CAPRICORN, Croesnewydd Hall, Wrecsam Technology Park, Wrecsam, UK
5 Institute of Medical and Social Care Research, University of Wales Bangor, UK

* To whom correspondence should be addressed.
Nefyn H. Williams, E-mail: williamsnh{at}cardiff.ac.uk


  Abstract

Background. Spinal pain is common and costly to health services and society. Management guidelines have encouraged primary care referral for spinal manipulation, but the evidence base is weak. More economic evaluations alongside pragmatic trials have been recommended.

Objective. Our aim was to assess the cost-utility of a practice-based osteopathy clinic for subacute spinal pain.

Methods. A cost-utility analysis was performed alongside a pragmatic single-centre randomized controlled trial in a primary care osteopathy clinic accepting referrals from 14 neighbouring practices in North West Wales. Patients with back pain of 2-12 weeks duration were randomly allocated to treatment with osteopathy plus usual GP care or usual GP care alone. Costs were measured from a National Health Service (NHS) perspective. All primary and secondary health care interventions recorded in GP notes were collected for the study period. We calculated quality adjusted life year (QALY) gains based on EQ-5D responses from patients in the trial, and then cost per QALY ratios. Confidence intervals (CIs) were estimated using non-parametric bootstrapping.

Results. Osteopathy plus usual GP care was more effective but resulted in more health care costs than usual GP care alone. The point estimate of the incremental cost per QALY ratio was £3560 (80% CI £542-£77 100). Sensitivity analysis examining spine-related costs alone and total costs excluding outliers resulted in lower cost per QALY ratios.

Conclusion. A primary care osteopathy clinic may be a cost-effective addition to usual GP care, but this conclusion was subject to considerable random error. Rigorous multi-centre studies are needed to assess the generalizability of this approach.

Keywords: Back pain; cost-utility; neck pain; osteopathy; primary care; QALY.
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