Cost Effectiveness of Physical Therapy Compared to Medication for Chronic Low Back Pain Treatment

Objective: Analyze the incremental cost-effectiveness of physical therapy treatment compared to medication treatment for patients with chronic low back pain using data from an ongoing observational cohort study focusing on participants with chronic low back pain. Methods: The data used in this analysis is from a cohort observational study focusing on phenotyping chronic low back pain in patients using biological, biomechanical, and behavioral domains. Participants were identified as having physical therapy only and medication only throughout their study period (12 months) based on a treatment assessment form. Chronic low back pain was categorized based on the Oswestry Disability Index (ODI) and the categories represented Markov states in the Markov transition state model. Quality-adjusted life years (QALYs) were estimated using an ordinary least squares regression model incorporating baseline characteristics including age, education, marital status, ODI, and pain interference. Costs for medication and physical therapy were estimated from the literature and the analysis compared the two treatments over a 2-year and 5-year period to enable both short- and longer-term evaluation based on a healthcare perspective. Results: A sample of 414 participants was used, 70 in the physical therapy group and 344 in the medications group. There were no significant differences between groups based on gender and comorbidities, but there were differences in age with the physical therapy group younger on average compared to the medication group. The physical therapy group gained 0.27 and 0.52 QALYs over 2 and 5 years, respectively. The incremental cost-effectiveness ratio was $277/QALY and $1,395/QALY gained over a 2- and 5-year period, respectively. Probabilistic sensitivity analysis indicated physical therapy had the highest probability of being cost-effective at a willingness to pay of $50,000/QALY gained. In the scenario analysis assuming 10% of participants in categories 3 and 4 of the medication group are affected by opioid addiction, the physical therapy group gained 0.27 and 0.52 QALYs over 2 and 5 years, respectively. The incremental cost-effectiveness ratio was $36/QALY and $1,039/QALY gained over 2- and 5-year periods, respectively. Conclusion: Physical therapy is a cost-effective treatment compared to medication for the treatment of chronic low back pain.