title: Cost-effectiveness of Acupuncture for Chronic Nonspecific Low Back Pain.
abstract: Cost-effectiveness is a major criterion underpinning decisions in mainstream health care. Acupuncture is increasingly used in patients with chronic lower back pain (LBP), but there is a lack of evidence on cost-effectiveness. The objective of this study was to assess the cost-effectiveness of acupuncture in alleviating chronic LBP either alone or in conjunction with standard care compared with patients receiving routine care, and/or sham. To determine effectiveness, we undertook meta-analyses which found a significant improvement in pain in those receiving acupuncture and standard care compared with those receiving standard care alone. For acupuncture and standard care vs. standard care and sham, a weak positive effect was found for weeks 12 to 16, but this was not significant. For acupuncture alone vs. standard care alone, a significant positive effect was found at week 8, but not at weeks 26 or 52. The main outcome parameters for our cost-effectiveness analysis were the incremental cost-effectiveness ratio (ICER) of acupuncture treatment presented as cost (A$) per disability-adjusted life-year (DALY) saved. The WHO benchmark for a very highly cost-effective intervention is one that costs less than gross domestic product per capita per quality-adjusted life-year (QALY) gained or DALY averted, or less than around $A52,000 in 2009 (the base year for the analysis). According to this threshold, acupuncture as a complement to standard care for relief of chronic LBP is highly cost-effective, costing around $48,562 per DALY avoided. When comorbid depression is alleviated at the same rate as pain, cost is around $18,960 per DALY avoided. Acupuncture as a substitute for standard care was not found to be cost-effective unless comorbid depression was included. According to the WHO cost-effectiveness threshold values, acupuncture is a cost-effective treatment strategy in patients with chronic LBP.
authors.affiliation: Deloitte Access Economics, Canberra, Australian Capital Territory, Australia.
authors.forename: Penny
authors.initials: P
authors.lastname: Taylor
authors.affiliation: Deloitte Access Economics, Canberra, Australian Capital Territory, Australia.
authors.forename: Lynne
authors.initials: L
authors.lastname: Pezzullo
authors.affiliation: National Institute of Complementary Medicine, University of Western Sydney, New South Wales, Australia.
authors.forename: Suzanne J
authors.initials: SJ
authors.lastname: Grant
authors.affiliation: National Institute of Complementary Medicine, University of Western Sydney, New South Wales, Australia.
authors.forename: Alan
authors.initials: A
authors.lastname: Bensoussan
mesh_terms: D015670:Acupuncture Therapy / Q000191:economics* / Q000379:methods; D000368:Aged; D003362:Cost-Benefit Analysis / Q000379:methods*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
keywords: acupuncture; acupuncture analgesia; back pain; cost-effectiveness; disability-adjusted life-year; low back pain; meta-analysis; quality-adjusted life-year