Key Takeaway
Six Alexander Technique lessons combined with exercise prescription was the most cost-effective intervention for chronic back pain at approximately 5,332 GBP per QALY gained, well below the NHS cost-effectiveness threshold.
Summary
This economic evaluation accompanied the landmark ATEAM randomized controlled trial, analyzing the cost-effectiveness of Alexander Technique lessons, massage, and exercise for 579 patients with chronic or recurrent low back pain. The analysis examined both costs and outcomes at 12-month follow-up, including quality-adjusted life years (QALYs), disability scores, and pain-free days.
Among single therapies, exercise prescription demonstrated the best value at 61 GBP per point improvement on the disability score, 9 GBP per additional pain-free day, and 2,847 GBP per QALY gained. For combined approaches, six Alexander Technique lessons plus exercise prescription emerged as the best value option at an additional 64 GBP per point on disability score, 43 GBP per pain-free day, and 5,332 GBP per QALY gained. The full 24-lesson course cost approximately 596 GBP per patient.
Both exercise alone and six Alexander Technique lessons combined with exercise exceeded an 85% probability of being cost-effective at the standard NHS threshold of 20,000 GBP per QALY. This finding was significant because it demonstrated that even a short course of Alexander Technique lessons, when combined with exercise, provides excellent value for money in treating chronic back pain within a public healthcare system.
Figures
Figure 1