Objective This study aimed to investigate the relationship between a previously purpose‐developed lifestyle behavior scale and health care cost savings related to low back pain (LBP). Methods This longitudinal study used data from the Australian Twin Back (AUTBACK) study. LBP and lifestyle behavior measures were collected at baseline. Physical activity (PA) was objectively quantified via an accelerometer. A lifestyle behavior scale was created using variables of body mass index, PA, smoking status, and sleep quality. Weekly health care use for LBP was collected over one year. Health care costs were calculated by aggregating expenses for health care visits and medications, encompassing personal and Australia Medicare costs, and analyzed by two‐part models. Results Individuals with lower lifestyle behavior scores, women, and those with a baseline episode of LBP were more likely to incur health care use costs (n = 307). A total of 2.6% of participants accounted for over 56% of the total expenditures. A one‐point improvement in the lifestyle behavior scale was significantly associated with 23% decrease in overall health care costs for LBP (95% confidence interval [CI] 7%−36%; P = 0.006), 25% decrease in medication costs for LBP (95% CI 13%−35%; P < 0.001), and 27% decrease in health care visit costs for LBP (95% CI 14%−39%; P < 0.001). The predicted difference in yearly health care use costs between individuals with the lowest and highest lifestyle scores was AU$873. Conclusion This study demonstrated the association between greater adherence to positive lifestyle behaviors and reduced health care costs related to LBP. Interventions aimed at improving lifestyle behaviors could yield substantial cost savings for individuals and the health care system, mitigating the burden of LBP.