title: Acupuncture of chronic headache disorders in primary care: randomised controlled trial and economic analysis.
abstract: OBJECTIVE
  To determine the effects of a policy of using acupuncture, compared with a policy of avoiding acupuncture, on headache in primary care patients with chronic headache disorders. The effects of acupuncture on medication use, quality of life, resource use and days off sick in this population and the cost-effectiveness of acupuncture were also examined.
  
  
  METHODS
  Randomised, controlled trial.
  
  
  METHODS
  General practices in England and Wales.
  
  
  METHODS
  The study included 401 patients with chronic headache disorder, predominantly migraine.
  
  
  METHODS
  Patients were randomly allocated to receive up to 12 acupuncture treatments over 3 months or to a control intervention offering usual care.
  
  
  METHODS
  Outcome measures included headache score; assessment of Short Form 36 (SF-36) health status and use of medication at baseline, 3 months and 12 months; assessment of use of resources every 3 months; and assessment of incremental cost per quality-adjusted life-year (QALY) gained.
  
  
  RESULTS
  Headache score at 12 months, the primary end-point, was lower in the acupuncture group than in controls. The adjusted difference between means was 4.6. This result was robust to sensitivity analysis incorporating imputation for missing data. Patients in the acupuncture group experienced the equivalent of 22 fewer days of headache per year. SF-36 data favoured acupuncture, although differences reached significance only for physical role functioning, energy and change in health. Compared with controls, patients randomised to acupuncture used 15% less medication, made 25% fewer visits to GPs and took 15% fewer days off sick. Total costs during the 1-year period of the study were on average higher for the acupuncture group than for controls because of the acupuncture practitioners' costs. The mean health gain from acupuncture during the year of the trial was 0.021 QALYs, leading to a base-case estimate of GBP9180 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
  The study suggests that acupuncture leads to persisting, clinically relevant benefits for primary care patients with chronic headache, particularly migraine. It is relatively cost-effective compared with a number of other interventions provided by the NHS. Further studies could examine the duration of acupuncture effects beyond 1 year and the relative benefit to patients with migraine with compared to tension-type headache. Trials are also warranted examining the effectiveness and cost-effectiveness of acupuncture in patients with headache receiving more aggressive pharmacological management.
authors.affiliation: Integrative Medicine Service, Biostatistics Service, Memorial Sloan-Kettering Cancer Center, New York, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Vickers
authors.forename: R W
authors.initials: RW
authors.lastname: Rees
authors.forename: C E
authors.initials: CE
authors.lastname: Zollman
authors.forename: R
authors.initials: R
authors.lastname: McCarney
authors.forename: C M
authors.initials: CM
authors.lastname: Smith
authors.forename: N
authors.initials: N
authors.lastname: Ellis
authors.forename: P
authors.initials: P
authors.lastname: Fisher
authors.forename: R
authors.initials: R
authors.lastname: Van Haselen
authors.forename: D
authors.initials: D
authors.lastname: Wonderling
authors.forename: R
authors.initials: R
authors.lastname: Grieve
mesh_terms: D026881:Acupuncture / Q000191:economics*; D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D006261:Headache / Q000145:classification / Q000191:economics / Q000628:therapy; D006801:Humans; D008875:Middle Aged; D011320:Primary Health Care / Q000191:economics*; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D016896:Treatment Outcome; D006113:United Kingdom