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Costs and Utilities of Manual Therapy and Orthopedic Standard Care for Low-prioritized Orthopedic Outpatients of Working Age: A Cost Consequence Analysis

Lilje, Stina C. DN*; Persson, Ulf B. PhD; Tangen, Stine T. DN; Kåsamoen, Stine DN; Skillgate, Eva PhD§

doi: 10.1097/AJP.0000000000000000
Original Articles

Objectives: Treatment for musculoskeletal disorders in primary care in Sweden is generally initiated with advice and medication. Second-line therapy is physiotherapy and/or injection and radiography; third-line therapy is referral to an orthopedist. Manual therapy is not routine. It is a challenge to identify patients who benefit from treatment by different specialists. The current referral strategy probably contributes to long waiting lists in orthopedic departments, which is costly and implies prolonged suffering for the patients. The aim of this health economic evaluation was to compare costs and outcomes from naprapathic manual therapy (NMT) with orthopedic standard care for common, low-prioritized, nonsurgical musculoskeletal disorders, after second-line treatment.

Materials and Methods: Diagnose Related Groups were used to define the costs, and the SF-36 was encoded to evaluate the outcomes in cost per quality adjusted life years gained.

Results: Results from a 12 months’ follow-up showed significantly larger improvement for the NMT than for orthopedic standard care, significantly lower mean cost per patient; 5427 SEK (*Price level 2009; 1 Euro=106,213 SEK; 1 US Dollar=76,457 SEK) (95% confidence interval, 3693-7161) compared to14298 SEK (95% confidence interval, 8322-20,274), and more gains in outcomes in cost per quality adjusted life years per patient (0.066 compared with 0.026). Thus the result is “dominant.”

Discussion: It is plausible that improved outcomes and reasonable cost savings for low-prioritized nonsurgical outpatients would be attainable if NMT were available as an additional standard care option in orthopedic outpatient clinics.

*Blekinge Institute of Technology, Gräsvik, Karlskrona

The Swedish Institute for Health Economics, Lund

Scandinavian College of Naprapathic Manual Medicine, Kräftriket

§Karolinska Institutet, Stockholm, Sweden

The authors declare no conflict of interest.

Reprints: Stina C. Lilje, DN, Blekinge Institute of Technology, Department for Health Sciences, SE-371 79 Karlskrona, Sweden (e-mail:

Received December 1, 2012

Accepted August 13, 2013

© 2014 by Lippincott Williams & Wilkins