Cost-Effectiveness of Acupuncture Care as an Adjunct to Exercise-Based Physical Therapy for Osteoarthritis of the Knee

In the U.K. and in Canada "quality-adjusted life years" can be part of their study's outcome measurements and cost-effectiveness. Since both countries have a National Health Service, it is in the Health Services interests to keep people well and in the work force as part of their charter. Since we don't have a collective system in the U.S. the main charter of the Health Insurance Companies is to deny care as much as possible, since their first duty is to their stock holders. But we are entitled to wonder why insurance companies are so reluctant to pay for relatively low cost, high safety profile treatments such as acupuncture. My take is that they are somewhat Machiavellian, in that, once they agree to pay for acupuncture it would lead to more acupuncture treatments, and hence more claims. But it is never discussed in terms of comparing one treatment modality to another, or quality of life. There is an ideological bias in favor of allopathic medicine, also, in spite of the higher costs and risks. I discussed that problem here. In this study they found that both non-penetrating acupuncture and penetrating acupuncture were superior to "advice and exercise" as a cost-effective therapeutic modality even though the cost of delivery was higher than for "advice and exercise" alone. I'm quoting the entire abstract in full for those
who would like to see the details of the analysis.

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Cost-Effectiveness of Acupuncture Care as an Adjunct to Exercise-Based Physical Therapy for Osteoarthritis of the Knee.

Whitehurst DG, Bryan S, Hay EM, Thomas E, Young J, Foster NE.

Centre for Clinical Epidemiology and Evaluation (C2E2), Vancouver Coastal Health Research Institute, 7th Floor, 828 West 10th Ave, Vancouver, British Columbia, V5Z 1M9 Canada. Dr Whitehurst also is Honorary Research Fellow, Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire, United Kingdom.
Abstract

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: /b> 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: /b> 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.

(Kristen Sparrow, MD Acupuncture, San Francisco)