Treatment group Mean cost* (£) Mean adjusted QALYs* Incremental cost effectiveness ratio to nearest £100 or comment Manipulation and exercise both available (n=1287) Best care in general practice 346 0.618 Best care plus exercise 486 0.635 Dominated by combined treatment, which costs less and gains more QALYs Best care plus manipulation and exercise 471 0.651 £3800 Best care plus manipulation 541 0.659 £8700 relative to manipulation and exercise Exercise not available (n=623) Best care in general practice 346 0.622 Best care plus manipulation 541 0.663 £4800 relative to best care Manipulation not available (n=668) Best care in general practice 346 0.610 Best care plus exercise 486 0.627 £8300 relative to best care

QALY=quality adjusted life year.

^* Markov Chain Monte Carlo estimates from bivariate multilevel model.

Estimated by analysis of covariance with adjustment for baseline EQ-5D score and then rounded to three significant figures.