Abstract Objectives To evaluate the cost-effectiveness of a work style (WS) intervention and a work style plus physical activity (WSPA) intervention in computer workers with neck and upper limb symptoms compared with usual care. Methods An economic evaluation was conducted from an employer's perspective and alongside a randomised controlled trial in which 466 computer workers with neck and upper limb symptoms were randomised to a WS group (N=152), a WSPA group (N=156) or a usual care group (N=158). Total costs were compared to the effects on recovery and pain intensity. In the primary analyses, missing effect data were imputed using multiple imputation techniques. Results Total costs during the 12-month intervention and follow-up period were _1907 (WS), _2811 (WSPA) and _2310 (usual care). Differences between groups were not statistically significant. Neither intervention was more effective than usual care in improving overall recovery. The WS intervention was more effective than usual care in reducing current pain, average pain and worst pain in the past 4?weeks, but the WSPA intervention was not. The acceptability curve showed that when a company is willing to pay approximately _900 for a 1-point reduction in average pain (scale from 0 to 10), the probability of cost-effectiveness compared to usual care is 95%. Similar results were observed for current and worst pain. Conclusions This study shows that the WS intervention was not cost-effective for improving recovery but was cost-effective for reducing pain intensity, although this reduction was not clinically significant. The WSPA intervention was not cost-effective compared with