OBJECTIVES: To assess the cost-effectiveness of acupuncture and usual care, and Alexander technique lessons and usual care, compared with usual GP care alone for chronic neck pain patients. METHODS: An economic evaluation was undertaken alongside the ATLAS trial, taking both NHS and wider societal viewpoints. Participants were offered up to twelve acupuncture sessions or twenty Alexander lessons (equivalent overall contact time). Costs were in pounds sterling. Effectiveness was measured using the generic EQ-5D to calculate quality adjusted life years (QALYs), as well as using a specific neck pain measure-the Northwick Park Neck Pain Questionnaire (NPQ). RESULTS: In the base case analysis, incremental QALY gains were 0.032 and 0.025 in the acupuncture and Alexander groups, respectively, in comparison to usual GP care, indicating moderate health benefits for both interventions. Incremental costs were Great British Pounds 451 for acupuncture and Great British Pounds 667 for Alexander, mainly driven by intervention costs. Acupuncture was likely to be cost-effective (ICER Great British Pounds 18,767/QALY bootstrapped 95% CI 4,426 to 74,562) and was robust to most sensitivity analyses. Alexander lessons were not cost-effective at the lower NICE threshold of Great British Pounds 20,000/QALY (Great British Pounds 25,101/QALY bootstrapped 95% CI -150,208 to 248,697) but may be at Great British Pounds 30,000/QALY, however, there was considerable statistical uncertainty in all tested scenarios. CONCLUSIONS: In comparison with usual care, acupuncture is likely to be cost-effective for chronic neck pain, whereas, largely due to higher intervention costs, Alexander lessons are unlikely to be cost-effective. However, there were high levels of missing data and further research is needed to assess the long-term cost-effectiveness of these interventions.

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