Article

The delivery of acupuncture alongside mainstream interventions and
the cost-effectiveness of "alternative" treatments remain areas of controversy.
The aim of this study was to assess the cost-utility of adding
acupuncture to a course of advice and exercise delivered by UK National Health
Service (NHS) physical therapists to people with osteoarthritis of the knee.
DESIGN: A cost-utility analysis was performed alongside a randomized controlled
trial. METHODS: A total of 352 adults (aged 50 years or older) were randomly
assigned to receive 1 of 3 interventions. The primary analysis focused on
participants receiving advice and exercise (AE) or advice and exercise plus true
acupuncture (AE+TA). A secondary analysis considered participants receiving
advice and exercise plus nonpenetrating acupuncture (AE+NPA). The main outcome
measures were quality-adjusted life years (QALYs), measured by the EQ-5D, and UK
NHS costs. RESULTS: were expressed as the incremental cost per QALY gained over
12 months. Sensitivity analyses included a broader cost perspective to
incorporate private out-of-pocket costs. Results NHS costs were higher for AE+TA
( pound314 [British pounds sterling]) than for AE alone ( pound229), and the
difference in mean QALYs favored AE+TA (mean difference=0.022). The base-case
cost per QALY gained was pound3,889; this value was associated with a 77%
probability that AE+TA would be more cost-effective than AE at a threshold of
pound20,000 per QALY. Cost-utility data for AE+NPA provided cost-effectiveness
estimates similar to those for AE+TA. LIMITATIONS: As with all trial-based
economic evaluations, caution should be exercised when generalizing results
beyond the study perspectives. CONCLUSIONS: A package of AE+TA delivered by NHS
physical therapists provided a cost-effective use of health care resources
despite an associated increase in costs. However, the economic benefits could not
be attributed to the penetrating nature of conventional acupuncture; therefore,
further research regarding the mechanisms of acupuncture is needed. An analysis
of alternative cost perspectives suggested that the results are generalizable to
other health care settings.

Langue : ANGLAIS