Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Dec 4, 2025
Date Accepted: Oct 1, 2026
Cost-effectiveness analysis: neck-specific exercises with internet support versus standard neck-specific exercise for the treatment of chronic whiplash-associated disorders
ABSTRACT
Background:
To assess the cost-effectiveness of an internet-based intervention (NSEIT) versus neck specific exercises (NSE) for chronic whiplash-associated disorders (WAD), we investigated the effectiveness of a three month neck-specific exercise with internet support in combination with four physiotherapy visits (NSEIT) compared to the same exercises performed twice a week (24 times) at a physiotherapy clinic (NSE).
Objective:
This study aimed to address the current scarce information about cost-effectiveness for individuals with chronic whiplash-associated disorders (WAD) and internet-based exercise programs for neck pain, including WAD.
Methods:
This is a prospective, multicentre, randomized controlled trial regarding secondary outcomes of cost-effectiveness in 140 individuals with chronic moderate/ severe WAD with three and 15-month follow-up. The main outcome was the incremental cost-effectiveness ratio (ICER).
Results:
The ICER estimation for QALYs was 381026.3 SEK/QALY, and the cost saving was 381026.3 SEK per QALY lost in the NSEIT group compared to NSE. The internet-based intervention was less costly and less effective than NSE at the 15-month follow-up; thus, the cost-effectiveness of the IT intervention may depend on decision-makers' willingness to accept the intervention.
Conclusions:
Healthcare costs are associated with both interventions, which impact the incremental cost-effectiveness ratio (ICER). Therefore, the overall wellbeing of patients should also be considered when treating WAD. Additionally, it is the physiotherapist's cost per session that makes the NSE more costly, although it is slightly cost-effective. Clinical Trial: ClinicalTrials.gov NCT03022812. Protocol registered before data collection started; https://clinicaltrials.gov/ct2/show/NCT03022812
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