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LETTERS: Charlotte Paterson Appraisals of specific treatments are needed BMJ 2007; 334: 600-a [Full text]

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cost effectiveness of placebo

Peter H Canter   (27 March 2007)

cost effectiveness of placebo 27 March 2007
Peter H Canter, Research Fellow in Complementary Medicine Complementary medicine, Peninsula Medical School, 25 Victoria Park Rd, Exeter EX2 4NT Send response to journal: Re: cost effectiveness of placebo	Charlotte Paterson misrepresents the findings of our systematic review of UK cost effectiveness studies of complementary therapies which was published in short form by the BMJ (1) and has since been updated and published in full (2) to include the the additional study of acupuncture in back pain(3)which she mentions. We pointed out that the apparently favourable estimates of cost per QALY were derived from a handful of pragmatic studies in modalities with very little convincing evidence for a specific effect in the indications studied. In the case of spinal manipulation (4 studies) and acupuncture (1 study) for back pain, effect sizes were small and of uncertain clinical relevance. The sixth and final pragmatic cost-effectiveness study study included was of acupuncture in migraine an indication where real and placebo acupuncture have been shown to be equally effective(4). Our main conclusion was that the favourable cost-effectiveness estimates probably represent the cost-effectiveness of placebo. Evaluation of CAM therapies by NICE is therefore premature for most CAM modalities because they are not supported by good evidence of a specific effect. Furthermore her inclusion of manual therapy for people with neck pain in her list of safe complementary therapies is just plain wrong. Neck pain is the one indication where the use of spinal manipulation and other manual therapies is raising growing safety concerns. references 1. Canter PH, Thompson Coon J, Ernst E. Cost effectiveness of complementary treatments in the United Kingdom: systematic review. BMJ 2005; 331: 880-881 2. Canter PH, Thompson Coon J, Ernst E Cost Effectiveness of Complementary Therapies in the United Kingdom – a systematic review eCAM 2006: doi 10.1093/ecam/nel044 3. Wonderling D, Vickers AJ, Grieve R, McCarney R. Cost effectiveness analysis of a randomised trial of acupuncture for chronic headache in primary care. BMJ 2004; 328(7442):747. 4. Linde K, Streng A, Jurgens S, Hoppe A, Brinkhaus B, Witt C, Wagenpfeil S, Pfaffenrath V, Hammes MG, Weidenhammer W, Willich SN, Melchart D. Acupuncture for patients with migraine: a randomized controlled trial. JAMA. 2005 May 4;293(17):2118-25. Competing interests: None declared