Costs and Utilities of Manual Therapy and Orthopedic Standard Care for Low Prioritized Orthopedic Outpatients of Working Age

Treatment for musculoskeletal disorders in primary care in Sweden is usually begun with advice and medication. Second line therapy is physiotherapy and/or injection and radiography; third line therapy is referral to an orthopedist. Manual therapy isn’t routine. It is difficult 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 lengthened suffering for the patients. The authors’ goal in this health economic evaluation is to compare costs and outcomes from naprapathic manual therapy (NMT) with orthopedic standard care for common, low prioritized, non surgical musculoskeletal disorders, after second line treatment. They used Diagnose Related Groups (DRG) to define the costs, and the SF-36 was encoded to evaluate the outcomes in cost per quality adjusted life years gained (QALYs). 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; 5 427 SEK* (95% CI; 3,693-7,161) compared to14 298 SEK (95% CI; 8,322-20,274), and more gains in QALYs per patient (0,066 compared to 0,026). Thus the result is “dominant”.


The authors’ concluded that it’s likely that better outcomes and reasonable cost savings for low prioritized non surgical outpatients could be attainable if NMT were available as an additional standard care option in orthopedic outpatient clinics. *) Price level 2009; 1 Euro=10,6213 SEK; 1 US Dollar=7,6457 SEK