Economic evaluation of long-term manual therapy for chronic neck pain: A Markov model-based analysis

Background The global burden of chronic neck pain is rising, increasing the importance of cost-effective pain management. Manual therapy may reduce economic and societal burden by preventing chronic pain recurrence, but supporting evidence is limited. This study evaluates the long-term cost-effectiveness of manual therapy compared with standard care for chronic neck pain. Methods A Markov model with three-month cycles is used to simulate health-state transitions over three years. Treatment alternatives include Chuna manual therapy (10 sessions twice weekly for five weeks) and usual care (oral medication and physical therapy, administered with the same frequency as Chuna). Clinical and economic data were sourced from pragmatic randomized controlled trials and official public documents. Costs (medical and non-medical) and utilities were estimated from the healthcare system and societal perspectives, and utility weights derived from the EuroQol five-dimension five-level scale. Sensitivity analyses assessed parameter uncertainty, including one-way and probabilistic sensitivity analyses. Results Over three years, Chuna manual therapy involved an additional cost of only $407, yielding 0.03 more quality-adjusted life years (QALY) compared to usual care, resulting in an incremental cost-effectiveness ratio of $14,125/QALY. Sensitivity analyses confirm cost-effectiveness at a willingness-to-pay threshold of $26,375/QALY in most scenarios. Probabilistic sensitivity analyses reveal cost-effectiveness probabilities of 77.2% and 98.5% from the healthcare and societal perspective, respectively. Conclusions Chuna manual therapy is a cost-effective intervention with clinical and economic advantages over usual care. The findings support policy decisions on extending health insurance coverage for long-term manual therapy and provide a foundation for future studies.