title: Cost-effectiveness of acupuncture care as an adjunct to exercise-based physical therapy for osteoarthritis of the knee.
abstract: BACKGROUND
  The delivery of acupuncture alongside mainstream interventions and the cost-effectiveness of "alternative" treatments remain areas of controversy.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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 (£314 [British pounds sterling]) than for AE alone (£229), and the difference in mean QALYs favored AE+TA (mean difference=0.022). The base-case cost per QALY gained was £3,889; this value was associated with a 77% probability that AE+TA would be more cost-effective than AE at a threshold of £20,000 per QALY. Cost-utility data for AE+NPA provided cost-effectiveness estimates similar to those for AE+TA.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Centre for Clinical Epidemiology and Evaluation (C2E2), Vancouver Coastal Health Research Institute, 7th Floor, 828 West 10th Ave, Vancouver, British Columbia, V5Z 1M9 Canada. david.whitehurst@ubc.ca
authors.forename: David G T
authors.initials: DG
authors.lastname: Whitehurst
authors.forename: Stirling
authors.initials: S
authors.lastname: Bryan
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Hay
authors.forename: Elaine
authors.initials: E
authors.lastname: Thomas
authors.forename: Julie
authors.initials: J
authors.lastname: Young
authors.forename: Nadine E
authors.initials: NE
authors.lastname: Foster
mesh_terms: D015670:Acupuncture Therapy / Q000191:economics* / Q000379:methods*; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D005081:Exercise Therapy / Q000191:economics* / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000191:economics* / Q000628:therapy*; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome; D006113:United Kingdom