A systematic review of cost-effectiveness analyses alongside randomised controlled trials of acupuncture

This comprehensive systematic review examined 17 economic studies that evaluated the cost-benefit of acupuncture in randomized clinical trials. The researchers conducted an extensive search of 11 electronic databases through March 2011, with no language restrictions, identifying studies that compared the costs and consequences of acupuncture for various medical conditions. The review included complete economic analyses such as cost-effectiveness analysis (CEA), cost-utility analysis (CUA), and cost-benefit analysis (CBA) performed alongside randomized clinical trials. The studies were conducted primarily in Germany (6 studies), the United Kingdom (4 studies), China (2 studies), and other countries, including the United States, Denmark, India, Italy, and Sweden.

The number of participants varied widely, from 20 to more than 3,000 patients per study. Most studies allowed concurrent conventional medical care with additional treatments as needed. Nine studies involved cost-utility analyses that measured health outcomes in terms of quality-adjusted life years (QALYs) gained, primarily using the SF-6D instrument converted from SF-36 values. All CUA studies reported incremental cost-effectiveness ratios (ICERs) to estimate economic outcomes and used bootstrapped cost-effectiveness acceptability curves to measure uncertainty.

The eight CEA studies measured primary outcomes in ICERs or compared costs and clinical improvement between groups. Costs were measured in various ways, including acupuncture treatment costs, medications, medical consultations, and hospital stay as direct health care costs. Acupuncture cost estimates showed differences between countries, ranging from £30-43 per hour in the United Kingdom, €35 per session in Germany, $45-60 per visit in the United States, and ¥40 per session in China. Patients received a mean of 15.6 acupuncture treatment sessions over a mean of 12.1 weeks.

The main results showed that all CUA studies demonstrated that acupuncture, with or without usual care, was cost-effective compared with waiting-list control or usual care alone. ICERs ranged from €3,011/QALY (dysmenorrhea) to €22,298/QALY (allergic rhinitis) in German studies, and from £3,855/QALY (osteoarthritis) to £9,951/QALY (headache) in U.K. studies. Across all CUAs, acupuncture was more effective than control but also more costly.

All CUA studies were well designed with low risk of bias, but this was not the case for the CEAs. Acupuncture was considered most cost-effective for dysmenorrhea and had the highest ICERs for allergic rhinitis. All CUA studies produced satisfactory results at every hypothetical acceptability threshold. The review also assessed safety, with 11 studies reporting adverse events from acupuncture and no serious adverse events reported.

Minor adverse events included discomfort, pain, minor local bleeding or hematoma, fainting, and nausea. The economic impact of the identified adverse events was not measured by any of these studies.