Comparison of the Cost-utility Analysis of Electroacupuncture and Nonsteroidal Antiinflammatory Drugs in the Treatment of Chronic Low Back Pain

This Iranian study was a pioneering economic analysis comparing electroacupuncture with nonsteroidal anti-inflammatory drugs (NSAIDs) for the treatment of chronic low back pain, a condition that affects approximately 51% of the Iranian population during their lifetime and is the second most common reason for medical visits. The research included 100 patients recruited from two hospitals and four authorized acupuncture clinics in Tehran, divided into two groups: 41 patients treated with electroacupuncture (at least 5 sessions in the past 6 months) and 59 patients using NSAIDs (for at least 6 months). The methodology adopted a comprehensive societal perspective, calculating direct medical costs, direct nonmedical costs, and indirect costs related to lost productivity. Quality of life was assessed with the EuroQol-5D questionnaire, while pain intensity was measured with a visual analog scale.

Results demonstrated significant superiority of electroacupuncture in both effectiveness and cost. The electroacupuncture group had a higher utility index (0.70 ± 0.14 versus 0.627 ± 0.2; p < 0.05), indicating better health-related quality of life. At the same time, total annual cost was significantly lower for electroacupuncture ($461.48 ± 57.8 USD versus $497.77 ± 85.2 USD; p < 0.05). Detailed cost analysis showed that direct medical costs accounted for the largest share (56.6% for electroacupuncture and 61.7% for NSAIDs), followed by indirect productivity-related costs (34.2% in both groups).

The average cost-effectiveness ratio showed that electroacupuncture was 134.64 units more efficient than NSAIDs. Because electroacupuncture demonstrated lower cost and greater effectiveness, it produced a negative incremental cost-effectiveness ratio, establishing it as the dominant treatment option. Groups were demographically comparable, with mean ages of 41 ± 2.3 years (electroacupuncture) and 38 ± 4.4 years (NSAIDs), without significant differences in sex, income, or employment status. However, the electroacupuncture group had a longer mean duration of chronic low back pain (3.4 ± 1.8 versus 2.3 ± 1.2 years; p < 0.05).

The clinical implications are substantial, given that chronic low back pain generates enormous economic costs through frequent medical visits, work absenteeism, and prolonged drug consumption. Electroacupuncture offers additional advantages because adverse events are rare when properly performed, contrasting with the well-known gastrointestinal, cardiovascular, and renal risks of NSAIDs. This superior safety profile reinforces the economic advantage of electroacupuncture, although adverse-event–related costs were not included in the analysis, which could further widen the cost-effectiveness gap. The study acknowledges important limitations, including a relatively small sample size, cross-sectional design without follow-up, and groups not matched for duration of chronic low back pain.

Despite these limitations, this research provides robust economic evidence regarding a widely used therapeutic modality, offering a scientific basis for decision-making in the health system. The findings suggest that electroacupuncture may be considered an economically advantageous therapeutic alternative, especially when integrated with preventive strategies and appropriately targeted drug therapy. The research contributes to the growing body of evidence on integrative medicine in chronic pain management, demonstrating that nonpharmacological approaches can offer significant clinical and economic benefits.