Are complementary therapies and integrative care cost-effective? A systematic review of economic evaluations

This comprehensive systematic review examined 338 economic evaluations of complementary and integrative medicine (CIM) published between 1979 and 2010, representing the largest study on the subject to date. The researchers used a broad search strategy across six databases, including PubMed, CINAHL, AMED, PsychInfo, Web of Science, and EMBASE, in addition to manual reference searching and consultation with experts. The study included a wide variety of complementary therapies, from acupuncture and chiropractic to nutritional supplements and naturopathic medicine, applied across different populations and health conditions. Of the total studies identified, 204 were published between 2001 and 2010, of which 114 were full economic evaluations.

The methodology of the study was rigorous, with two independent reviewers evaluating all articles and applying multiple quality measures. The researchers developed five specific quality criteria to identify the most reliable studies: comparison with usual care, recognized economic perspective, health outcomes from controlled trials, patient-specific cost and outcome data, and sensitivity analyses. Only 31 studies (27%) met all five quality criteria. The results showed that the quality of CIM studies is comparable to that observed in economic evaluations of conventional medicine.

Using the 35-item BMJ checklist, the studies showed an average of 72% conformance with the quality criteria, with high-quality studies achieving 87%. Particularly notable was the improvement in methodologic quality over time, with a significant increase in the appropriate use of discounting and inclusion of sensitivity analyses. Among the 31 high-quality studies, which generated 56 economic comparisons, 16 (29%) demonstrated cost savings — that is, CIM therapies provided better health outcomes at lower costs compared with conventional care. This percentage is notably higher than the 9% of cost-saving studies found in conventional medicine reviews.

Therapies that showed cost savings included acupuncture for chronic low back pain, manual therapy for neck pain, preoperative supplementation with arginine and omega-3, vitamin K for osteoporosis, antioxidants for cataract prevention, omega-3 for secondary cardiovascular prevention, tai chi for fracture prevention in the elderly, and naturopathic care for chronic low back pain. In cost-utility analyses, 89% of studies showed incremental cost-effectiveness ratios below $50,000 per quality-adjusted life year (QALY), a threshold frequently considered cost-effective. The clinical implications are significant. The results suggest that several CIM therapies may offer substantial economic value to the health care system, especially when used as adjuvant therapies to conventional care.

This is particularly relevant in the current context of rising health care costs and the search for cost-effective interventions. The study also identified important gaps in the literature. Although most CIM users use multiple modalities, only one study examined the effect of multiple CIM practitioners. This suggests a need for more research on integrative care models that better reflect real clinical practice.

Limitations include the inability to blind reviewers to authors and journals, potential publication bias not assessed, and difficulty in judging some methodologic aspects solely from what was reported in the studies. In addition, the economic results are specific to the contexts studied and may not be directly transferable to other health systems because of differences in practice patterns and relative prices.