The George Institute for Global Health and Sydney Medical School, The University of Sydney, PO Box M201, Missenden Rd, Sydney, NSW 2050, Australia.
Eur Spine J. 2011 Jul;20(7):1024-38. doi: 10.1007/s00586-010-1676-3. Epub 2011 Jan 13.
Healthcare costs for low back pain (LBP) are increasing rapidly. Hence, it is important to provide treatments that are effective and cost-effective. The purpose of this systematic review was to investigate the cost-effectiveness of guideline-endorsed treatments for LBP. We searched nine clinical and economic electronic databases and the reference list of relevant systematic reviews and included studies for eligible studies. Economic evaluations conducted alongside randomised controlled trials investigating treatments for LBP endorsed by the guideline of the American College of Physicians and the American Pain Society were included. Two independent reviewers screened search results and extracted data. Data extracted included the type and perspective of the economic evaluation, the treatment comparators, and the relative cost-effectiveness of the treatment comparators. Twenty-six studies were included. Most studies found that interdisciplinary rehabilitation, exercise, acupuncture, spinal manipulation or cognitive-behavioural therapy were cost-effective in people with sub-acute or chronic LBP. Massage alone was unlikely to be cost-effective. There were inconsistent results on the cost-effectiveness of advice, insufficient evidence on spinal manipulation for people with acute LBP, and no evidence on the cost-effectiveness of medications, yoga or relaxation. This review found evidence supporting the cost-effectiveness of the guideline-endorsed treatments of interdisciplinary rehabilitation, exercise, acupuncture, spinal manipulation and cognitive-behavioural therapy for sub-acute or chronic LBP. There is little or inconsistent evidence for other treatments endorsed in the guideline.
腰痛（LBP）的医疗保健费用正在迅速增加。因此，提供有效且具有成本效益的治疗方法非常重要。本系统评价的目的是调查指南认可的 LBP 治疗方法的成本效益。我们搜索了九个临床和经济电子数据库以及相关系统评价的参考文献列表，并纳入了符合条件的研究。纳入了与美国医师学院和美国疼痛协会指南认可的治疗腰痛的随机对照试验同时进行的经济评估。两名独立评审员筛选了搜索结果并提取了数据。提取的数据包括经济评估的类型和视角、治疗比较以及治疗比较的相对成本效益。共纳入 26 项研究。大多数研究发现，对于亚急性或慢性 LBP 患者，跨学科康复、运动、针灸、脊柱推拿或认知行为疗法具有成本效益。单独按摩不太可能具有成本效益。对于建议、急性 LBP 患者的脊柱推拿的成本效益证据不足，以及药物、瑜伽或放松的成本效益缺乏证据，存在不一致的结果。本综述发现了支持跨学科康复、运动、针灸、脊柱推拿和认知行为疗法等指南认可的治疗方法在亚急性或慢性 LBP 中具有成本效益的证据。指南中认可的其他治疗方法的证据很少或不一致。
