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

doi:10.1136/bmj.38033.896505.EB

BMJ, 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 ¹, Andrew J Vickers ², Richard Grieve ¹, Rob McCarney ³

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

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

Design Cost effectivenessanalysis of a randomised controlled trial.

Setting General practicesin England and Wales.

Participants 401 patients with chronicheadache, predominantly migraine.

Interventions Patients wererandomly allocated to receive up to 12 acupuncture treatmentsover three months from appropriately trained physiotherapists,or to usual care alone.

Main outcome measure Incremental costper quality adjusted life year (QALY) gained.

Results Total costsduring the one year period of the study were on average higherfor the acupuncture group (£403; $768; 598 euros) thanfor controls (£217) because of the acupuncture practitioners'costs. The mean health gain from acupuncture during the oneyear of the trial was 0.021 quality adjusted life years (QALYs),leading to a base case estimate of £9180 per QALY gained.This result was robust to sensitivity analysis. Cost per QALYdropped substantially when the analysis incorporated likelyQALY differences for the years after the trial.

Conclusions Acupuncturefor chronic headache improves health related quality of lifeat a small additional cost; it is relatively cost effectivecompared with a number of other interventions provided by theNHS.

(Accepted 21 January 2004)

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