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A Pragmatic Multicentered Randomized Controlled Trial of Yoga for Chronic Low Back Pain: Economic Evaluation

Chuang, Ling-Hsiang PhD*; Soares, Marta O. MSc; Tilbrook, Helen MSc*; Cox, Helen MSc*; Hewitt, Catherine E. PhD*; Aplin, John PhD; Semlyen, Anna MSc§; Trewhela, Alison DBL, CSL; Watt, Ian MB, ChB*,‖; Torgerson, David J. PhD*

doi: 10.1097/BRS.0b013e3182545937
Health Services Research

Study Design. Multicentered randomized controlled trial with quality of life and resource use data collected.

Objective. The objective of this study was to evaluate the cost-effectiveness of yoga intervention plus usual care compared with usual care alone for chronic or recurrent low back pain.

Summary of Background Data. Yoga has been shown as an effective intervention for treating chronic or recurrent low back pain. However, there is little evidence on its cost-effectiveness. The data are extracted from a pragmatic, multicentered, randomized controlled trial that has been conducted to evaluate the effectiveness and cost-effectiveness of a 12-week progressive program of yoga plus usual care in patients with chronic or recurrent low back pain.

Methods. With this trial data, a cost-effectiveness analysis during the time period of 12 months from both perspectives of the UK National Health Service and the societal is presented. Main outcome measure is an incremental cost per quality-adjusted life-year (QALY).

Results. From the perspective of the UK National Health Service, yoga intervention yields an incremental cost-effectiveness ratio of £13,606 per QALY. Given a willingness to pay for an additional QALY of £20,000, the probability of yoga intervention being cost-effective is 72%. From the perspective of the society, yoga intervention is a dominant treatment compared with usual care alone. This result is surrounded by fewer uncertainties—the probability of yoga being cost-effective reaches 95% at a willingness to pay for an additional QALY of £20,000. Sensitive analyses suggest the same results that yoga intervention is likely to be cost-effective in both perspectives.

Conclusion. On the basis of this trial, 12 weekly group classes of specialized yoga are likely to be a cost-effective intervention for treating patients with chronic or recurrent low back pain.

The aim of this study was to investigate the cost-effectiveness of 12 weekly group classes of specialized yoga intervention plus usual care compared with usual care alone for chronic and recurrent low back pain. Based on the trial data, yoga intervention is likely to be cost-effective.

*York Trials Unit, Department of Health Sciences, The University of York, Heslington, York, United Kingdom

Centre for Health Economics, The University of York, Heslington, York, United Kingdom

Maternal and Fetal Health Research, Manchester Academic Health Science Centre, University of Manchester, St Mary's Hospital, Manchester, United Kingdom

§British Wheel of Yoga Practitioner, York, United Kingdom

SBRCP-Yoga, Cornwall, United Kingdom

Hull York Medical School, The University of York, Heslington, York, United Kingdom.

Address correspondence and reprint requests to Marta O. Soares, MSc, Centre for Health Economics, Alcuin ‘A' block, University of York, York, YO10 5DD, United Kingdom; E-mail: Marta.soares@york.ac.uk

Acknowledgment date: July 8, 2011. First revision date: October 20, 2011. Second revision date: January 20, 2012. Acceptance date: March 3, 2012.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Arthritis Research UK grant funds were received to support this work.

One or more of the author(s) has/have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this manuscript: e.g., honoraria, gifts, consultancies, royalties, stocks, stock options, decision-making position.

© 2012 Lippincott Williams & Wilkins, Inc.