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pandora necklaces Design Stochastic cost utility analysis alongside pragmatic randomised trial with factorial design.Setting 181 general practices and 63 community settings for physical treatments around 14 centres across the United Kingdom.Participants 1287 (96%) of 1334 trial participants.Main outcome measures Healthcare costs, quality adjusted life years (QALYs), and cost per QALY over 12 months.Results Over one year, mean treatment costs relative to “best care” were 195 ($360; 279; 95% credibility interval 85 to 308) for manipulation, 140 (3 to 278) for exercise, and 125 (21 to 228) for combined treatment. All three active treatments increased participants’ average QALYs compared with best care alone. Each extra QALY that combined treatment yielded relative to best care cost 3800; in economic terms it had an “incremental cost effectiveness ratio” of 3800. pandora necklaces

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