| Cost-effectiveness of acupuncture care as an adjunct to exercise-based physical therapy for osteoarthritis of the knee. | |
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MedLine Citation:
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PMID: 21415230 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The delivery of acupuncture alongside mainstream interventions and the cost-effectiveness of "alternative" treatments remain areas of controversy. OBJECTIVE: The aim of this study was to assess the cost-utility of adding acupuncture to a course of advice and exercise delivered by UK National Health Service (NHS) physical therapists to people with osteoarthritis of the knee. DESIGN: A cost-utility analysis was performed alongside a randomized controlled trial. METHODS: A total of 352 adults (aged 50 years or older) were randomly assigned to receive 1 of 3 interventions. The primary analysis focused on participants receiving advice and exercise (AE) or advice and exercise plus true acupuncture (AE+TA). A secondary analysis considered participants receiving advice and exercise plus nonpenetrating acupuncture (AE+NPA). The main outcome measures were quality-adjusted life years (QALYs), measured by the EQ-5D, and UK NHS costs. RESULTS: were expressed as the incremental cost per QALY gained over 12 months. Sensitivity analyses included a broader cost perspective to incorporate private out-of-pocket costs. Results NHS costs were higher for AE+TA (£314 [British pounds sterling]) than for AE alone (£229), and the difference in mean QALYs favored AE+TA (mean difference=0.022). The base-case cost per QALY gained was £3,889; this value was associated with a 77% probability that AE+TA would be more cost-effective than AE at a threshold of £20,000 per QALY. Cost-utility data for AE+NPA provided cost-effectiveness estimates similar to those for AE+TA. LIMITATIONS: As with all trial-based economic evaluations, caution should be exercised when generalizing results beyond the study perspectives. CONCLUSIONS: A package of AE+TA delivered by NHS physical therapists provided a cost-effective use of health care resources despite an associated increase in costs. However, the economic benefits could not be attributed to the penetrating nature of conventional acupuncture; therefore, further research regarding the mechanisms of acupuncture is needed. An analysis of alternative cost perspectives suggested that the results are generalizable to other health care settings. |
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Authors:
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David G T Whitehurst; Stirling Bryan; Elaine M Hay; Elaine Thomas; Julie Young; Nadine E Foster |
Publication Detail:
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Type: Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't Date: 2011-03-17 |
Journal Detail:
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Title: Physical therapy Volume: 91 ISSN: 1538-6724 ISO Abbreviation: Phys Ther Publication Date: 2011 May |
Date Detail:
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Created Date: 2011-05-02 Completed Date: 2011-07-26 Revised Date: 2011-12-01 |
Medline Journal Info:
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Nlm Unique ID: 0022623 Medline TA: Phys Ther Country: United States |
Other Details:
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Languages: eng Pagination: 630-41 Citation Subset: AIM; IM |
Affiliation:
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Centre for Clinical Epidemiology and Evaluation (C2E2), Vancouver Coastal Health Research Institute, 7th Floor, 828 West 10th Ave, Vancouver, British Columbia, V5Z 1M9 Canada. david.whitehurst@ubc.ca |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acupuncture Therapy
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economics*,
methods* Combined Modality Therapy Cost-Benefit Analysis Exercise Therapy / economics*, methods* Female Great Britain Humans Male Middle Aged Osteoarthritis, Knee / economics*, therapy* Quality-Adjusted Life Years Treatment Outcome |
| Grant Support | |
ID/Acronym/Agency:
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H0640//Arthritis Research UK |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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