Cost-Effectiveness of Acupuncture Care as an Adjunct to Exercise-Based Physical Therapy for Osteoarthritis of the Knee

Whitehurst, D. G.

Bryan, S.

Hay, E. M.

Thomas, E.

Young, J.

Foster, N. E.

Physical therapy

2011

RCT

Arthritis

Osteoarthritis, Knee

RCT

Acu + Usual Care Versus > 1 Control

Acupuncture

TCM Acupuncture Style

Semi-Individualized Acupuncture Protocol

Sham Control

Non Penetrating Sham, Mechanical

Verum Acupoint Control

Knee Pain

Usual Care Control, Multimodality

Restricted Modalities, Acupuncture Only

Symptom Based Point Selection

Background The delivery of acupuncture alongside mainstream interventions and the cost-effectiveness of "alternative" treatments remain areas of controversy. Objective The aim of this study was to assess the cost-utility of adding acupuncture to a course of advice and exercise delivered by UK National Health Service (NHS) physical therapists to people with osteoarthritis of the knee. Design A cost-utility analysis was performed alongside a randomized controlled trial. METHODS: A total of 352 adults (aged 50 years or older) were randomly assigned to receive 1 of 3 interventions. The primary analysis focused on participants receiving advice and exercise (AE) or advice and exercise plus true acupuncture (AE+TA). A secondary analysis considered participants receiving advice and exercise plus nonpenetrating acupuncture (AE+NPA). The main outcome measures were quality-adjusted life years (QALYs), measured by the EQ-5D, and UK NHS costs. RESULTS: were expressed as the incremental cost per QALY gained over 12 months. Sensitivity analyses included a broader cost perspective to incorporate private out-of-pocket costs. Results NHS costs were higher for AE+TA ( pound314 [British pounds sterling]) than for AE alone ( pound229), and the difference in mean QALYs favored AE+TA (mean difference=0.022). The base-case cost per QALY gained was pound3,889; this value was associated with a 77% probability that AE+TA would be more cost-effective than AE at a threshold of pound20,000 per QALY. Cost-utility data for AE+NPA provided cost-effectiveness estimates similar to those for AE+TA. Limitations As with all trial-based economic evaluations, caution should be exercised when generalizing results beyond the study perspectives. CONCLUSIONS:/b> A package of AE+TA delivered by NHS physical therapists provided a cost-effective use of health care resources despite an associated increase in costs. However, the economic benefits could not be attributed to the penetrating nature of conventional acupuncture; therefore, further research regarding the mechanisms of acupuncture is needed. An analysis of alternative cost perspectives suggested that the results are generalizable to other health care settings.

Arthritis

1/WK

352

6 Weeks