Cost-effectiveness of acupuncture for tension-type headaches in Japan: a multicenter, prospective, single-arm clinical trial

This prospective multicenter study investigated for the first time in Japan the cost-effectiveness of acupuncture in the treatment of tension-type headache, a condition that affects 22.3% of the population and causes significant impact on quality of life. The research was conducted at 19 acupuncture clinics with 37 participants (predominantly women, 94.6%) who received acupuncture as adjunctive treatment to standard therapy for three months. The methodology included standardized assessments of health-related quality of life (EQ-5D-5L), headache-related costs, headache frequency and intensity, and impact on daily activities (HIT-6). Participants received an average of 12.2 acupuncture sessions, with a median cost of ¥2,929 per session.

The most commonly used acupuncture points were GB-21, BL-10, and GB-20, selected by acupuncturists based on pre-established protocols and clinical criteria such as local tenderness. Results demonstrated significant efficacy of acupuncture across multiple parameters. Headache frequency and intensity decreased significantly after the intervention period. The HIT-6 score, which measures the impact of headache on daily activities, also improved in a statistically significant manner.

Quality of life, measured by the EQ-5D-5L, increased from 0.83 to 0.90, indicating substantial improvement in patients' overall well-being. The cost-effectiveness analysis revealed striking results. The median ICER (Incremental Cost-Effectiveness Ratio) was only ¥484 (USD 5) per QALY (Quality-Adjusted Life Year) gained. This value is well below internationally established cost-effectiveness thresholds and within the range Japanese residents would be willing to pay per QALY, which varies between ¥6.35 and ¥6.70 million.

For comparison, other countries set much higher thresholds: Australia AUD 36,000, Canada CAD 20,000, the United States USD 50,000, and the United Kingdom GBP 30,000 per QALY. The median incremental QALY in the study was 1.4 [0.0-7.3], with a mean of 3.2, indicating substantial gains in quality-adjusted life years. Interestingly, headache-related costs increased during the intervention period (from ¥8,000 to ¥38,700), mainly due to the costs of acupuncture, but this increase was more than offset by the gains in quality of life. Clinical implications are significant.

The study provides robust evidence that acupuncture represents a highly cost-effective therapeutic option for tension-type headache in the Japanese setting. Considering that tension-type headache is the most prevalent form of primary headache and causes considerable economic and social burden, these results suggest that incorporation of acupuncture into treatment protocols could offer substantial economic benefits to the health system. The study also contributes to the growing body of evidence on cost-effective complementary therapies, an area of increasing importance in the era of value-based medicine. In the international context, this study corroborates findings from European research that also demonstrated favorable cost-effectiveness of acupuncture for primary headaches, although with higher ICER values, possibly due to differences in health systems and economic conditions.

The research sets an important precedent for future economic evaluation studies of complementary therapies in Japan and provides a solid basis for discussions on health policy and insurance coverage for acupuncture treatments.