Document Detail


Cost-effectiveness of acupuncture care as an adjunct to exercise-based physical therapy for osteoarthritis of the knee.
MedLine Citation:
PMID:  21415230     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
David G T Whitehurst; Stirling Bryan; Elaine M Hay; Elaine Thomas; Julie Young; Nadine E Foster
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2011-03-17
Journal Detail:
Title:  Physical therapy     Volume:  91     ISSN:  1538-6724     ISO Abbreviation:  Phys Ther     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-05-02     Completed Date:  2011-07-26     Revised Date:  2011-12-01    
Medline Journal Info:
Nlm Unique ID:  0022623     Medline TA:  Phys Ther     Country:  United States    
Other Details:
Languages:  eng     Pagination:  630-41     Citation Subset:  AIM; IM    
Affiliation:
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
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MeSH Terms
Descriptor/Qualifier:
Acupuncture Therapy / 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:
H0640//Arthritis Research UK

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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