Cost effectiveness analysis of a randomised trial of acupuncture for chronic headache in primary care

doi:10.1136/bmj.38033.896505.EB

BMJ 2004;328:747 (27 March), doi:10.1136/bmj.38033.896505.EB (published 15 March 2004)

Primary care

Cost effectiveness analysis of a randomised trial of acupuncture for chronic headache in primary care

David Wonderling, lecturer in health economics¹, Andrew J Vickers, assistant attending research methodologist², Richard Grieve, lecturer in health economics¹, Rob McCarney, research officer³

¹ Health Services Research Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT, ² Integrative Medicine Service, Biostatistics Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA, ³ Department of Psychological Medicine, Imperial College London, London W2 1PD

Correspondence to: D Wonderling David.Wonderling{at}lshtm.ac.uk

Objective To evaluate the cost effectiveness of acupuncturein the management of chronic headache.

Design Cost effectiveness analysis of a randomised controlledtrial.

Setting General practices in England and Wales.

Participants 401 patients with chronic headache, predominantlymigraine.

Interventions Patients were randomly allocated to receive upto 12 acupuncture treatments over three months from appropriatelytrained physiotherapists, or to usual care alone.

Main outcome measure Incremental cost per quality adjusted lifeyear (QALY) gained.

Results Total costs during the one year period of the studywere on average higher for the acupuncture group (£403;$768; ${euro}$ 598) than for controls (£217) because of the acupuncturepractitioners' costs. The mean health gain from acupunctureduring the one year of the trial was 0.021 quality adjustedlife years (QALYs), leading to a base case estimate of £9180per QALY gained. This result was robust to sensitivity analysis.Cost per QALY dropped substantially when the analysis incorporatedlikely QALY differences for the years after the trial.

Conclusions Acupuncture for chronic headache improves healthrelated quality of life at a small additional cost; it is relativelycost effective compared with a number of other interventionsprovided by the NHS.

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