title: Cost-effectiveness of acupuncture for irritable bowel syndrome: findings from an economic evaluation conducted alongside a pragmatic randomised controlled trial in primary care.
abstract: BACKGROUND
  There is insufficient evidence to determine whether acupuncture is a cost-effective treatment for irritable bowel syndrome. The objective of this study is to assess the cost-effectiveness of acupuncture as an adjunct to usual care versus usual care alone for the treatment of Irritable Bowel Syndrome (IBS).
  
  
  METHODS
  Cost-utility analysis conducted alongside a pragmatic, multicentre, randomised controlled trial. 233 patients with irritable bowel syndrome were randomly allocated to either acupuncture plus usual care, or usual care alone. Cost-effectiveness outcomes are expressed in terms of incremental cost per quality adjusted life year (QALY) at one year after randomisation. Costs were estimated from the UK National Health Service perspective for a time horizon of one year. Cost-utility ratios were estimated based on complete case analysis for the base case analysis, where only patients with available EQ-5D and cost data were included. Sensitivity analyses comprised a multiple imputation approach for missing data and a subgroup analysis for the more severe cases of IBS.
  
  
  RESULTS
  The base case analysis showed acupuncture to be marginally more effective than usual care (gain of 0.0035 QALYs, 95% CI: -0.00395 to 0.0465) and more expensive (incremental cost of £218 per patient (95% CI: 55.87 to 492.87) resulting in an incremental cost-effectiveness ratio of approximately £62,500. Sensitivity analysis using multiple imputation for missing data resulted in acupuncture appearing less effective and more costly than usual care, so usual care is dominant. Subgroup analysis selecting the most severe cases of IBS (Symptom Severity Score of over 300) suggested that acupuncture may be a cost-effective treatment option for this group, with a cost-per-QALY of £6,500.
  
  
  CONCLUSIONS
  Acupuncture as an adjunct to usual care is not a cost-effective option for the whole IBS population; however it may be cost-effective for those with more severe irritable bowel syndrome.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN08827905.
authors.affiliation: Department of Health Sciences, University of York, York YO10 5DD, UK. eugena.stamuli@york.ac.uk
authors.forename: Eugena
authors.initials: E
authors.lastname: Stamuli
authors.forename: Karen
authors.initials: K
authors.lastname: Bloor
authors.forename: Hugh
authors.initials: H
authors.lastname: MacPherson
authors.forename: Helen
authors.initials: H
authors.lastname: Tilbrook
authors.forename: Tracy
authors.initials: T
authors.lastname: Stuardi
authors.forename: Sally
authors.initials: S
authors.lastname: Brabyn
authors.forename: David
authors.initials: D
authors.lastname: Torgerson
mesh_terms: D015670:Acupuncture Therapy / Q000191:economics*; D003131:Combined Modality Therapy / Q000191:economics; D016001:Confidence Intervals; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000191:economics* / Q000628:therapy*; D011320:Primary Health Care / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012720:Severity of Illness Index; D006113:United Kingdom