|| ●BMJ（British Medical Journal)英国医師会誌（2008.12.11付）
||2008 年12 月11 日つけの研究報告
Published 11 December 2008, doi:10.1136/bmj.a2656
Cite this as: BMJ 2008;337:a2656
Randomised controlled trial of Alexander technique lessons,exercise, and massage (ATEAM) for chronic and recurrent
back pain: economic evaluation
Objective An economic evaluation of therapeutic massage, exercise, and lessons in the Alexandertechnique for treating persistent back pain.
Design Cost consequences study and cost effectiveness analysis at 12 month follow-up of a factorial randomised controlled trial.
Participants 579 patients with chronic or recurrent low back pain recruited from primary care. Interventions Normal care (control), massage, and six or 24 lessons in the Alexander technique.
Half ofeach group were randomised to a prescription for exercise from a doctor plus behavioural counselling froma nurse.
Main outcome measures Costs to the NHS and to participants. Comparison of costs with Roland-Morrisdisability score (number of activities impaired by pain), days in pain, and quality adjusted life years (QALYs).
Comparison of NHS costs with QALY gain, using incremental cost effectiveness ratios and cost effectiveness acceptability curves.
Results Intervention costs ranged from ￡30 for exercise prescription to ￡596 for 24 lessons in Alexander technique plus exercise. Cost of health services ranged from ￡50 for 24 lessons in Alexander technique to
￡124 for exercise. Incremental cost effectiveness analysis of single therapies showed that exercise offered best value (￡61 per point on disability score, ￡9 per additional pain-free day, ￡2847 per QALY gain). For two-stage therapy, six lessons in Alexander technique combined with exercise was the best value (additional ￡64 per point on disability score, ￡43 per additional pain-free day, ￡5332 per QALY gain).
Conclusions An exercise prescription and six lessons in Alexander technique alone were both more than 85% likely to be cost effective at values above ￡20 000 per QALY, but the Alexander technique performedbetter than exercise on the full range of outcomes. A combination of six lessons in Alexander technique
lessons followed by exercise was the most effective and cost effective option.