Skip to main content

Advertisement

SpringerLink
Log in

Quality of life and cost-effectiveness of acupuncture treatment in patients with osteoarthritis pain

  • Original paper
  • Published:
The European Journal of Health Economics Aims and scope Submit manuscript

Abstract

To assess quality of life (QoL), costs, and cost-effectiveness of acupuncture treatment plus routine care versus routine care alone in osteoarthritis patients, a randomised, controlled trial was conducted in 255 general practices in Germany. Four hundred and eighty-nine patients with chronic pain due to osteoarthritis of the knee or hip were included to evaluated QoL and costs at baseline and after 3 months using health insurance funds data and standardized questionnaires. Patients receiving acupuncture had an improved QoL associated with significantly higher costs over the 3 months treatment period compared to routine care alone (mean cost-difference: €469.50 [95%CI €135.80–€803.19]). This increase in costs was primarily due to the costs of acupuncture. The overall ICER was €17,845 per QALY gained. The degree of cost-effectiveness was influenced by gender, with female patients achieving a better cost-effectiveness ratio than men. In conclusion, acupuncture was a cost-effective treatment strategy in patients with chronic osteoarthritis pain.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines: Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. Arthritis. Rheum. 43, 1905 (2000)

    Article  Google Scholar 

  2. Badley, E.M.: Population projections and the effect on rheumatology. Ann. Rheum. Dis. 50, 3 (1991)

    Article  Google Scholar 

  3. Berman, B.M., Lao, L., Langenberg, P., Lee, W.L., Gilpin, A.M., Hochberg, M.C.: Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial. Ann. Intern. Med. 141, 901 (2004)

    Google Scholar 

  4. Brazier, J., Roberts, J., Deverill, M.: The estimation of a preference-based measure of health from the SF-36. J. Health. Econ. 21, 271 (2002)

    Article  Google Scholar 

  5. Brinkhaus, B., Witt, C.M., Jena, S., Linde, K., Streng, A., Wagenpfeil, S., Irnich, D., Walther, H.U., Melchart, D., Willich, S.N.: Acupuncture in patients with chronic low back pain–a randomised controlled trial. Arch. Intern. Med. 166, 450 (2006)

    Article  Google Scholar 

  6. Bullinger, M., Kirchberger, I.: SF-36 Fragebogen zum Gesundheitszustand. Hogrefe, Göttingen (1998)

    Google Scholar 

  7. Claxton, K.: The irrelevance of inference: a decision-making approach to the stochastic evaluation of health care technologies. J. Health. Econ. 18, 341 (1999)

    Article  Google Scholar 

  8. Coyle, D., Tolley, K.: Discounting of health benefits in the pharmacoeconomic analysis of drug therapies: an issue for debate? Pharmacoeconomics 2, 153 (1992)

    Article  Google Scholar 

  9. Creamer, P., Hochberg, M.C.: Osteoarthritis. Lancet 350, 503 (1997)

    Article  Google Scholar 

  10. Eisenberg, D.M., Davis, R.B., Ettner, S.L., Appel, S., Wilkey, S., Van-Rompay, M., Kessler, R.C.: Trends in alternative medicine use in the United States, 1990–1997: results of a follow-up national survey. JAMA 280, 1569 (1998)

    Article  Google Scholar 

  11. Elders, M.J.: The increasing impact of arthritis on public health. J. Rheumatol. Suppl. 60, 6 (2000)

    Google Scholar 

  12. Ezzo, J., Hadhazy, V., Birch, S., Lao, L., Kaplan, G., Hochberg, M., Berman, B.: Acupuncture for osteoarthritis of the knee: a systematic review. Arthritis. Rheum. 44, 819 (2001)

    Article  Google Scholar 

  13. Federal statistical department Germany population health insurance coverage, Germany 2003. Statistical annual for Germany 2004. 2004

  14. Gosden, T., Forland, F., Kristiansen, I.S., Sutton, M., Leese, B., Giuffrida, A., Sergison, M., Pedersen, L.: Capitation, salary, fee-for-service and mixed systems of payment: effects on the behaviour of primary care physicians. Cochrane. Database. Syst. Rev. CD002215 (2000)

  15. Gosden, T., Forland, F., Kristiansen, I.S., Sutton, M., Leese, B., Giuffrida, A., Sergison, M., Pedersen, L.: Impact of payment method on behaviour of primary care physicians: a systematic review. J. Health. Serv. Res. Policy 6, 44 (2001)

    Article  Google Scholar 

  16. Gupta, S., Hawker, G.A., Laporte, A., Croxford, R., Coyte, P.C.: The economic burden of disabling hip and knee osteoarthritis (OA) from the perspective of individuals living with this condition. Rheumatology. (Oxford) 44, 1531 (2005)

    Article  Google Scholar 

  17. Hanoverian Consensus-Group: German recommendations for health economic evaluations–revised version of the Hanover Consensus. Gesundh. Ökon. Qual. Manag. 4, A62–A65 (1999)

    Google Scholar 

  18. Härtel, U., Volger, E.: Inanspruchnahme und akzeptanz klassischer naturheilverfahren und alternativer heilmethoden in Deutschland-ergebnisse einer repräsentativen bevölkerungsstudie. Forsch. Komplementärmed. Klass. Naturheilkd. 11, 327 (2004)

    Article  Google Scholar 

  19. Kassenärztliche Bundesvereinigung, Einheitlicher Bewertungsmaßstab 2000 plus (EBM2000plus), 2007

  20. Kosinski, M., Keller, S.D., Hatoum, H.T., Kong, S.X., Ware, J.E. Jr.: The SF-36 Health Survey as a generic outcome measure in clinical trials of patients with osteoarthritis and rheumatoid arthritis: tests of data quality, scaling assumptions and score reliability. Med. Care. 37, MS10–MS22 (1999)

    Article  Google Scholar 

  21. Kosinski, M., Keller, S.D., Ware, J.E., Jr., Hatoum, H.T., Kong, S.X.: The SF-36 Health Survey as a generic outcome measure in clinical trials of patients with osteoarthritis and rheumatoid arthritis: relative validity of scales in relation to clinical measures of arthritis severity. Med. Care. 37, MS23–MS39 (1999)

    Article  Google Scholar 

  22. Lothgren, M., Zethraeus, N.: Definition, interpretation and calculation of cost-effectiveness acceptability curves. Health. Econ. 9, 623 (2000)

    Article  Google Scholar 

  23. Murray, C.J., Lopez, A.D.: Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet 349, 1436 (1997)

    Article  Google Scholar 

  24. Paterson, C., Britten, N.: Acupuncture as a complex intervention: a holistic model. J. Altern. Complement. Med. 10, 791 (2004)

    Google Scholar 

  25. Patrick, D.L., Ramsey, S.D., Spencer, A.C., Kinne, S., Belza, B., Topolski, T.D.: Economic evaluation of aquatic exercise for persons with osteoarthritis. Med. Care. 39, 413 (2001)

    Article  Google Scholar 

  26. Pickard, A.S., Wang, Z., Walton, S.M., Lee, T.A.: Are decisions using cost-utility analyses robust to choice of SF-36/SF-12 preference-based algorithm? Health. Qual. Life. Outcomes. 3, 11 (2005)

    Article  Google Scholar 

  27. Raftery, J.: NICE: faster access to modern treatments? Analysis of guidance on health technologies. BMJ 323, 1300 (2001)

    Article  Google Scholar 

  28. Richardson, G., Manca, A.: Calculation of quality adjusted life years in the published literature: a review of methodology and transparency. Health. Econ. 13, 1203 (2004)

    Article  Google Scholar 

  29. Spiegel, B.M., Targownik, L., Dulai, G.S., Gralnek, I.M.: The cost-effectiveness of cyclooxygenase-2 selective inhibitors in the management of chronic arthritis. Ann. Intern. Med. 20(138), 795 (2003)

    Google Scholar 

  30. Thomas, K.J., Nicholl, J.P., Coleman, P.: Use and expenditure on complementary medicine in England: a population based survey. Complement. Ther. Med. 9, 2 (2001)

    Article  Google Scholar 

  31. Thomas, K.J., MacPherson, H., Ratcliffe, J., Thorpe, L., Brazier, J., Campbell, M., Fitter, M., Roman, M., Walters, S., Nicholl, J.P.: Longer term clinical and economic benefits of offering acupuncture care to patients with chronic low back pain. Health. Technol. Assess. 9, 1 (2005)

    Google Scholar 

  32. Thompson, S.G., Barber, J.A.: How should cost data in pragmatic randomised trials be analysed? BMJ 320, 1197 (2000)

    Article  Google Scholar 

  33. Tramer, M.R., Moore, R.A., Reynolds, D.J., McQuay, H.J.: Quantitative estimation of rare adverse events which follow a biological progression: a new model applied to chronic NSAID use. Pain 85, 169 (2000)

    Article  Google Scholar 

  34. Vickers, A., Zollman, C.: ABC of complementary medicine. Acupuncture. BMJ 319, 973 (1999)

    Google Scholar 

  35. Willich, S.N., Reinhold, T., Selim, D., Jena, S., Brinkhaus, B., Witt, C.M.: Cost-effectiveness of acupuncture treatment in patients with chronic neck pain. Pain 125, 107 (2006)

    Article  Google Scholar 

  36. Witt, C., Brinkhaus, B., Jena, S., Linde, K., Streng, A., Wagenpfeil, S., Hummelsberger, J., Walther, H.U., Melchart, D., Willich, S.N.: Acupuncture in patients with osteoarthritis of the knee: a randomised trial. Lancet 366, 136 (2005)

    Article  Google Scholar 

  37. Witt, C., Brinkhaus, B., Jena, S., Selim, D., Straub, J., Willich, S.N.: Wirksamkeit, sicherheit und wirtschaftlichkeit der akupunktur-ein modellvorhaben mit der techniker krankenkasse. Dtsch. Arztebl. 103, A196 (2006)

    Google Scholar 

  38. Witt, C.M., Jena, S., Brinkhaus, B., Liecker, B., Wegscheider, K., Willich, S.N.: Acupuncture in patients with osteoarthritis of the knee and the hip. Arthritis. and Rheum. 4, 3485 (2006)

    Article  Google Scholar 

  39. Wonderling, D., Vickers, A.J., Grieve, R., McCarney, R.: Cost effectiveness analysis of a randomised trial of acupuncture for chronic headache in primary care. BMJ 328, 747 (2004)

    Article  Google Scholar 

  40. Yen, Z.S., Lai, M.S., Wang, C.T., Chen, L.S., Chen, S.C., Chen, W.J., Hou, S.M.: Cost-effectiveness of treatment strategies for osteoarthritis of the knee in Taiwan. J. Rheumatol. 31, 1797 (2004)

    Google Scholar 

  41. Zethraeus, N., Johannesson, M., Jonsson, B., Lothgren, M., Tambour, M.: Advantages of using the net-benefit approach for analysing uncertainty in economic evaluation studies. Pharmacoeconomics 21, 39 (2003)

    Article  Google Scholar 

Download references

Acknowledgments

We would like to thank Katja Wruck for data management, Iris Bartsch and Beatrice Eden for data acquisition, the members of the advisory board (Dr. Bodo Liecker, Dr. Konrad Beyer, Dr. Josef Hummelsberger, Hardy Müller, Dr. Albrecht Molsberger, Dr. Helmut Rüdinger, Dr. Wolfram Stör, Dr. Gabriel Stux) for helpful advice and Niels Balthasar and Jürgen Schwabe for health economic data management. In addition, we would like to express our gratitude to all participating patients and physicians. Conflict of interest: All authors declare that they had no conflict of interest. Competing Interests: Funding: Study activities were funded by the following German social health insurance funds: Techniker Krankenkasse (TK); BKK Aktiv; Betriebskrankenkasse der Allianz Gesellschaften; Bertelsmann BKK; Bosch BKK; BKK BMW; DaimlerChrysler BKK; BKK Deutsche Bank; Ford Betriebskrankenkasse; BKK Hoechst; HypoVereinsbank Betriebskrankenkasse; Siemens-Betriebskrankenkasse; Handelskrankenkasse; Innungskrankenkasse Hamburg. Role of the Funding Source: The trial was initiated at the request of the German health authorities (Federal Committee of Physicians and Social Health Insurance Companies, German Federal Social Insurance Authority) and sponsored by a number of German Social Health Insurance companies. All decisions on design, data collection, analysis, interpretation, and publication were left completely to discretion of the researchers. Authors’ Contributions: All authors participated in planning the protocol and revising the drafts of the manuscript. Specific tasks and responsibilities: general trial coordination (CMW, SJ, DS), statistical analysis and economic expertise (TR, DS, SJ, CMW, SNW), overall medical and scientific responsibility (SNW).

Author information

Authors and Affiliations

  1. Institute for Social Medicine, Epidemiology, and Health Economics, Charité University Medical Center, Berlin, Germany

    Thomas Reinhold, Claudia M. Witt, Susanne Jena, Benno Brinkhaus & Stefan N. Willich

Authors
  1. Thomas Reinhold
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Claudia M. Witt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Susanne Jena
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Benno Brinkhaus
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stefan N. Willich
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thomas Reinhold.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Reinhold, T., Witt, C.M., Jena, S. et al. Quality of life and cost-effectiveness of acupuncture treatment in patients with osteoarthritis pain. Eur J Health Econ 9, 209–219 (2008). https://doi.org/10.1007/s10198-007-0062-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10198-007-0062-5

Keywords

Search

Navigation