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Low back pain is the leading cause of disability worldwide, yet despite many treatment options being recommended in clinical guidelines, little has been known about which deliver the best value for money. This systematic review, published in PLoS Medicine, searched ten electronic databases up to February 2026 to identify cost-effectiveness studies of guideline-recommended, non-pharmacological and non-surgical treatments for non-specific low back pain.
Twenty studies were included — seventeen within-trial economic evaluations and three modelling studies — published between 2005 and 2026. Half focused on chronic low back pain (lasting more than three months), and most examined populations from high-income countries. The primary outcome was cost per quality-adjusted life year, converted to 2024 Great British Pound values. Methodological quality was assessed using established health economics checklists.
The review found that most non-pharmacological interventions were cost-effective at a willingness-to-pay threshold of £20,000 per quality-adjusted life year. Notably, clinician-delivered interventions — including acupuncture, yoga, cognitive therapy, and self-management support — were identified as potentially cost-saving compared with usual care, meaning they were both more effective and less costly. Interventions targeting fear, stress, and self-management in people with chronic low back pain showed particular promise from healthcare, societal, and payer perspectives.
The authors call for improved access to these treatments in routine care, while noting that evidence from low- and middle-income countries remains limited.
Conclusion: This systematic review supports acupuncture as a cost-effective and potentially cost-saving option for managing low back pain when compared with usual care.
Source: Mathieson S, Underwood M, Ibrahim M and colleagues. PLoS medicine (2026). View on PubMed (PMID 42945153) · doi:10.1371/journal.pmed.1005273