Cost-effectiveness of acupuncture for irritable bowel syndrome: findings from an economic evaluation conducted alongside a pragmatic randomised controlled trial in primary care

This pioneering study performed a comprehensive economic analysis of acupuncture for irritable bowel syndrome (IBS) as part of a pragmatic randomized controlled trial within the English National Health Service. Irritable bowel syndrome affects between 2.1% and 22% of the population, causing symptoms such as abdominal pain, altered bowel habits, and bloating, with substantial impact on quality of life and substantial costs to the health system through medical visits and hospitalizations. The study enrolled 233 patients in primary care, randomizing 116 to receive traditional acupuncture (up to 10 sessions over 3 months) plus usual care and 117 to usual care alone. The methods followed rigorous economic evaluation principles, taking the perspective of the British NHS over a 1-year time horizon.

Costs included physician visits, hospitalizations, specialist consultations, and acupuncture sessions, while outcomes were measured with the EQ-5D instrument to calculate quality-adjusted life years (QALYs). Base-case results showed acupuncture provided a marginal gain of 0.0035 QALYs (95% CI, -0.00395 to 0.0465) at an incremental cost of £218.50 per patient, yielding an incremental cost-effectiveness ratio of approximately £62,500 per QALY gained. This ratio substantially exceeds the £30,000 per QALY threshold typically accepted by the NHS, with only a 40% probability of being cost-effective at that threshold. Sensitivity analysis using multiple imputation for missing data showed even less favorable results, with usual care being dominant (more effective and less costly).

Notably, subgroup analysis revealed promising results for patients with severe IBS (symptom severity score > 300), where acupuncture showed an incremental cost-effectiveness ratio of £6,500 per QALY, with a 60% probability of being cost-effective. Patients in the acupuncture group used more health services during the study, including more physician visits (6.7 vs 5.9) and nurse visits (2.5 vs 2.0), in addition to the cost of acupuncture sessions (£339 on average). Utility scores showed minimal differences between groups over time, with no statistically significant variations. Clinical implications suggest that, although safe, acupuncture is not an efficient use of public resources for the general IBS population.

However, there may be benefit for the subgroup of severely symptomatic patients, who frequently respond inadequately to conventional treatments and have markedly reduced quality of life. Limitations include substantial missing data, exclusion of medication costs, and limited statistical power for subgroup analyses. The study provides important evidence for public health decision-makers, indicating that limited resources may be better directed to other interventions in the general IBS population, although additional research focused specifically on severe cases may be warranted.