OBJECTIVE: To perform a cost-minimization analysis of three conservative treatment regimes for acute low-back pain (LBP). DESIGN: A prospective randomized clinical trial. Patients were assigned at random to one of three treatment programmes: general practitioner programme (GPP) controls, manual therapy programme (MTP) or intensive training programme (ITP). SETTING: Primary care and physiotherapists in Stockholm, Sweden. PATIENTS: 180 patients sick-listed for acute LBP. MAIN OUTCOME MEASURES: Direct, indirect and total costs for three treatment programmes. RESULTS: The direct costs for treatment were lowest in the GPP group -- 2,744 Swedish crowns (SEK) per patient. More patients in the MTP and ITP underwent operations for disk hernia and radiological investigations than in the GPP. Indirect costs, defined as sick-leave for LBP represent about 90% of the total cost. CONCLUSIONS: With respect to total costs, the findings were similar between the three treatment programmes. The GPP had the lowest direct costs. It is not possible to conclude which treatment programme is to be recommended as a least cost alternative. The strong effect of indirect costs on the total cost stresses that further studies should focus on methods of shortening sick-leave.

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