Economic analysis of acupuncture for migraine prophylaxis

This prospective economic study evaluated the cost-effectiveness of acupuncture as adjuvant therapy in migraine prophylaxis in the Czech Republic. An open-label randomized clinical trial was conducted comparing acupuncture combined with standard pharmacotherapy versus standard pharmacotherapy alone, with analysis of direct and indirect costs from three perspectives: third-party payer, patient, and society.

The study included 86 patients diagnosed with migraine, ages 18 to 70 years and a minimum of 4 migraine days per month. Participants were randomized to an acupuncture group (n=42) and a waiting-list control group (n=44). The treatment protocol consisted of 14 sessions of semi-standardized acupuncture over 12 weeks, followed by 6 months of follow-up. The primary endpoint was the comparison of total costs between groups, including direct medical costs, direct nonmedical costs, and indirect costs.

The results demonstrated significant clinical efficacy of acupuncture, with a reduction of 2 migraine days after 3 months and 4 days after 6 months of follow-up. The treatment response rate (≥50% reduction in frequency) was 81% in the acupuncture group versus 36% in the control group at 6 months. There was also a significant reduction in symptomatic medication use and improvement in migraine-specific quality of life.

From an economic perspective, although no statistically significant differences were found between the groups, an important trend was observed. During the 3-month treatment period, total costs were higher in the acupuncture group (€696 vs €285) primarily due to costs of sessions and travel. However, at 6-month follow-up, this trend reversed, with lower costs in the acupuncture group (€66 vs €132, p=0.071).

The analysis by perspectives revealed that the greatest economic benefits of acupuncture derived from the reduction of indirect costs, particularly loss of productivity and lost workdays. In the acupuncture group, there was a gradual reduction of these costs over time: from €134.3 at baseline to €13.9 at 6 months. From the patient's perspective, although direct costs are initially higher due to acupuncture sessions, there are subsequent savings on medications and medical consultations.

From the third-party payer perspective, a trend toward reduced medication reimbursement costs was observed in the acupuncture group, both during treatment (€25.6 per patient) and during follow-up (€29.3). Emergency department visits related to migraine were also significantly lower during treatment with acupuncture.

This study is pioneering in the economic analysis of acupuncture for migraine in the Czech Republic and one of the few to examine multiple cost categories from different perspectives. The results suggest that, although acupuncture increases initial healthcare costs, the long-term economic benefits, especially in reducing indirect costs, may justify its inclusion as adjuvant therapy in migraine prophylaxis.