title: Inconsistencies in NICE guidance for acupuncture: reanalysis and discussion.
abstract: BACKGROUND
  Acupuncture received a positive recommendation in the National Institute for Health and Clinical Excellence (NICE) clinical guideline for low back pain (LBP). However, no such recommendation was forthcoming in the NICE clinical guideline for osteoarthritis (OA). Importantly, the two guidelines adopted different treatment comparators in their economic analyses of acupuncture; in the LBP guideline 'usual care' was used (with no consideration of placebo/sham interventions), whereas 'sham acupuncture' was the comparator in the OA guideline.
  
  
  OBJECTIVE
  To analyse the implications of using different control group comparators when estimating the cost-effectiveness of acupuncture therapy.
  
  
  METHODS
  The NICE OA economic analysis for acupuncture was replicated using 'usual care' (ie, no placebo/sham component) as the treatment comparator. A 'transfer-to-utility' technique was used to transform Western Ontario and McMaster Osteoarthritis scores into EQ-5D utility scores to allow quality-adjusted life year (QALY) gains to be estimated. QALY estimates were combined with direct incremental cost estimates of acupuncture treatment to determine incremental cost-effectiveness ratios (ICERs).
  
  
  RESULTS
  When 'usual care' was used as the treatment comparator, ICER point estimates were below £20 000 per QALY gained for each acupuncture trial analysed in the OA clinical guideline. In the original analysis, using placebo/sham acupuncture as the treatment comparator, ICERs were generally above £20 000 per QALY gained.
  
  
  CONCLUSIONS
  The treatment comparator chosen in economic evaluations of acupuncture therapy is likely to be a strong determinant of the cost-effectiveness results. Different comparators used in the OA and LBP NICE guidelines may have led to the divergent recommendations in the guidelines.
authors: University of Sheffield, Health Economics and Decision Science, School of Health and Related Research, UK n.latimer@sheffield.ac.uk
authors: Nicholas R
authors: NR
authors: Latimer
authors: Aathish Chandrika
authors: AC
authors: Bhanu
authors: David G T
authors: DG
authors: Whitehurst
mesh_terms: D015670:Acupuncture Therapy / Q000191:economics; D003362:Cost-Benefit Analysis; D017408:Guidelines as Topic; D006801:Humans; D017116:Low Back Pain / Q000191:economics / Q000628:therapy*; D009316:National Institutes of Health (U.S.); D010003:Osteoarthritis / Q000191:economics / Q000628:therapy*; D019057:Quality-Adjusted Life Years; D014481:United States