Intended for healthcare professionals


A randomised controlled trial of acupuncture care for persistent low back pain: cost effectiveness analysis

BMJ 2006; 333 doi: (Published 21 September 2006) Cite this as: BMJ 2006;333:626
  1. J Ratcliffe (j.ratcliffe{at}, senior research fellow1,
  2. K J Thomas, reader1,
  3. H MacPherson, research director2,
  4. J Brazier, professor1
  1. 1 School of Health and Related Research, University of Sheffield,
  2. 2Foundation for Traditional Chinese Medicine, York YO24 1ET
  1. Correspondence to: J Ratcliffe
  • Accepted 27 July 2006


Objective To evaluate the cost effectiveness of acupuncture in the management of persistent non-specific low back pain.

Design Cost effectiveness analysis of a randomised controlled trial.

Setting Three private acupuncture clinics and 18 general practices in York, England.

Participants 241 adults aged 18-65 with non-specific low back pain of 4-52 weeks' duration.

Interventions Ten individualised acupuncture treatments over three months from acupuncturists trained in traditional Chinese medicine (n = 160) or usual care only (n = 81).

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

Results Total costs to the United Kingdom's health service during the two year study period were higher on average for the acupuncture group (£460; €673; $859) than for the usual care group (£345) because of the costs associated with initial treatment. The mean incremental health gain from acupuncture at 12 months was 0.012 QALYs (95% confidence interval −0.033 to 0.058) and at 24 months was 0.027 QALYs (−0.056 to 0.110), leading to a base case estimate of £4241 per QALY gained. This result was robust to sensitivity analysis. The probabilistic sensitivity analysis showed acupuncture to have a more than 90% chance of being cost effective at a £20 000 cost per QALY threshold.

Conclusion A short course of traditional acupuncture for persistent non-specific low back pain in primary care confers a modest health benefit for minor extra cost to the NHS compared with usual care. Acupuncture care for low back pain seems to be cost effective in the longer term.

Trial registration ISRCTN80764175 [].


  • Contributors KJT was principal investigator and implemented the study. JB developed the economic evaluation protocol. LT, HMacP, and JB secured funding for the 24 month follow up. LT collected costing data. JR and JB carried out the economic analysis. JR wrote the original draft with JB. All authors commented on the draft and the interpretation of the findings. JR and JB are guarantors.

  • Funding This study was funded by the UK NHS Executive health technology programme. The views and opinions expressed do not necessarily reflect those of the NHS Executive. York Health Authority funded the treatment costs of the acupuncture. The National Coordinating Centre for Health Technology Assessment reviewed the protocol and the final report but had no direct involvement in the research process. KJT and JB joined the commissioning group of the National Coordinating Centre for Health Technology Assessment after funding for this study was awarded. JonNicholl is currently chair of the National Coordinating Centre for Health Technology Assessment commissioning group.

  • Competing interests None declared.

  • Ethical approval: This study was approved by York research ethics committee.

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