Cost-effectiveness of recommended interventions for managing low back pain: A systematic review
PLoS Medicine · 27 Oct 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
Knowing that guideline-endorsed conservative care for non-specific low back pain is usually good value supports referring patients to exercise, psychological and self-management programmes rather than escalating to costlier invasive care.
The evidence
This systematic review gathered economic evaluations (20 papers, 24 studies, 55 comparisons, about 14,900 adults) of non-surgical treatments for non-specific low back pain that are recommended by WHO, NICE or NASS guidelines, each compared with usual first-contact care. Most interventions were cost-effective at a threshold of 20,000 pounds per QALY (for example 14 of 18 comparisons from a healthcare perspective and 15 of 19 from a societal perspective), and several, such as yoga, CBT, self-management support and fear-reduction education, were both cheaper and more effective than usual care. No data were pooled, all studies came from high-income countries, and no drug or surgical treatments had eligible economic data.
A coherent primary effect estimate is unavailable. Clinical relevance does not estimate treatment benefit.
Why this rigour score?
Systematic reviewDesign starting point: 50.4
Raised the score
- Prospectively registered+5.1
- Compared against current standard of care+3.4
Lowered the score
- Pools mixed study designs−3.4
Methods at a glance
Recorded assessment- Comprehensive literature searchMet
- Risk of bias assessedMet
- Bias considered in synthesisNot met
- Publication bias assessedNot met
- Study exclusions justifiedMet
- Prospective registrationMet
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
See the full score breakdown
- Study design starting point
- 50.4
- Compared against current standard of care
- +3.4
- Prospectively registered
- +5.1
- Pools mixed study designs
- −3.4
- Comprehensive literature search
- +3.4
- Risk of bias assessed in the included studies
- +3.4
- Excluded studies listed and justified
- +1.7
- Final rigour score rounded
- 64 / 100
Study design sets the starting point and a ceiling of 88. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.When counselling a patient with chronic non-specific low back pain who asks for an injection or a surgical opinion, how would you use the evidence that yoga, CBT and self-management programmes are often cost-saving to frame first-line options?
2.Given that massage and acupuncture showed inconsistent cost-effectiveness across settings, how should a spine clinic decide which conservative therapies to offer or refer to for its local population?
Original publication title
Cost-effectiveness of recommended interventions for managing low back pain: A systematic review