Study Design. An economic evaluation alongside a randomized controlled trial comparing behavioral graded activity (BGA) with manual therapy (MT). Objective. To evaluate the cost-effectiveness of BGA in comparison with MT for patients with subacute neck pain from a societal perspective. Summary of Background Data. Neck pain is common and poses an important socioeconomic burden to society. Data on the cost-effectiveness of treatments for neck pain are scarce. Methods. A randomized clinical trial was conducted, involving 146 patients with subacute nonspeci c neck pain. The BGA program can be described as a time-contingent increase in activities from baseline toward predetermined goals. MT consists of speci c spinal mobilization techniques and exercises. Clinical outcomes included recovery, pain, disability, and quality-adjusted life-years (QALYs). Costs were measured from a societal perspective using cost diaries. The follow-up period was 52 weeks. Multiple imputation was used for missing cost and effect data. Uncertainty surrounding cost differences and incremental cost-effectiveness ratios was estimated N eck pain is common in the adult general popula-tion. A recent review reported 12-month prevalence estimates ranging from 30% to 50%. Estimates of 12-month prevalences of neck pain limiting activities range from 2% to 11%. 1 A review on the course of neck pain in workers found that between 60% and 80% of workers with neck pain reported neck pain 1 year later. 2 Neck pain poses an important socioeconomic burden to society because pain and stiffness associated with neck pain often result in utilization of diagnostic assessments and treat-ments and absenteeism from work. 3 In the Netherlands, the annual costs of neck pain were estimated to be $686 (€€623) in 1996. 4 In Ontario, it was estimated that in workers making lost-time claims in 1998, 3% to 11% were absent from work because of neck pain. 5 The therapeutic modalities that are most frequently used for the treatment of neck pain are exercises, manipulative therapies, mobilization, massage, physical modalities, and multidisciplinary biopsychosocial rehabilitation. 6 Although the evidence regarding the effectiveness of most forms of ther-apy for neck pain is still inconclusive, the updated Cochrane review carried out by Gross et al 7 concluded that there is evi-dence for manipulation and/or mobilization if combined with