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Primary Care

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

BMJ 2004; 328 doi: (Published 25 March 2004) Cite this as: BMJ 2004;328:747
  1. David Wonderling, lecturer in health economics1 (David.Wonderling{at},
  2. Andrew J Vickers, assistant attending research methodologist2,
  3. Richard Grieve, lecturer in health economics1,
  4. Rob McCarney, research officer3
  1. 1Health Services Research Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT
  2. 2Integrative Medicine Service, Biostatistics Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA
  3. 3Department of Psychological Medicine, Imperial College London, London W2 1PD
  1. Correspondence to: D Wonderling
  • Accepted 21 January 2004


Objective To evaluate the cost effectiveness of acupuncture in the management of chronic headache.

Design Cost effectiveness analysis of a randomised controlled trial.

Setting General practices in England and Wales.

Participants 401 patients with chronic headache, predominantly migraine.

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

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

Results Total costs during the one year period of the study were on average higher for the acupuncture group (£403; $768;€598) than for controls (£217) because of the acupuncture practitioners' costs. The mean health gain from acupuncture during the one year 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 QALY dropped substantially when the analysis incorporated likely QALY differences for the years after the trial.

Conclusions Acupuncture for chronic headache improves health related quality of life at a small additional cost; it is relatively cost effective compared with a number of other interventions provided by the NHS.


  • Contributors DW undertook the economic analyses and is the study guarantor; AJV conceived and designed the randomised trial and advised on statistical aspects of the economic analyses; RG advised on the analyses; RM contributed to design of resource outcome assessment.

  • Funding NHS R&D National Coordinating Centre for Health Technology Assessment (NCCHTA) Grant: 96/40/15

  • Conflict of interests None declared

  • Ethical approval Ethical approval was received from South West Multi-centre Research Ethics Committee and appropriate local ethics committees.

  • Accepted 21 January 2004
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