A randomised controlled trial of acupuncture care for persistent low back pain: cost effectiveness analysis

Ratcliffe, J.

Thomas, K. J.

MacPherson, H.

Brazier, J.

2006

333(7569)

626-

RCT

Acu + Usual Care Versus Usual Care

Acupuncture

Back Pain

Low Back Pain, Chronic

Cost Effectiveness

Individualized Acupuncture Protocol

Low Back Pain

Pain

RCT

Restricted Modalities, Acupuncture Only

Usual Care Control, Unspecified

TCM Acupuncture Style

Traditional Diagnosis Based Point Selection

Musculoskeletal Diseases

Musculoskeletal Pain

AcuTrials

OBJECTIVE: To evaluate the cost effectiveness of acupuncture in the management of persistent non-specific low back pain. DESIGN: Cost effectiveness analysis of a randomised controlled trial. SETTING: Three private acupuncture clinics and 18 general practices in York, England. PARTICIPANTS: 241 adults aged 18-65 with non-specific low back pain of 4-52 weeks' duration. INTERVENTIONS: Ten individualised acupuncture treatments over three months from acupuncturists trained in traditional Chinese medicine (n = 160) or usual care only (n = 81). MAIN OUTCOME MEASURE: Incremental cost per quality adjusted life year (QALY) gained over two years. RESULTS: Total costs to the United Kingdom's health service during the two year study period were higher on average for the acupuncture group (460 pounds sterling; 673 euros; 859 dollars) than for the usual care group (345 pounds sterling) because of the costs associated with initial treatment. The mean incremental health gain from acupuncture at 12 months was 0.012 QALYs (95% confidence interval -0.033 to 0.058) and at 24 months was 0.027 QALYs (-0.056 to 0.110), leading to a base case estimate of 4241 pounds sterling per QALY gained. This result was robust to sensitivity analysis. The probabilistic sensitivity analysis showed acupuncture to have a more than 90% chance of being cost effective at a pound20 000 cost per QALY threshold. CONCLUSION: A short course of traditional acupuncture for persistent non-specific low back pain in primary care confers a modest health benefit for minor extra cost to the NHS compared with usual care. Acupuncture care for low back pain seems to be cost effective in the longer term. TRIAL REGISTRATION: ISRCTN80764175 [controlled-trials.com]

241

Back Pain

<1/WK

241

12 Weeks