title: Cost-effectiveness analysis of acupuncture, counselling and usual care in treating patients with depression: the results of the ACUDep trial.
abstract: BACKGROUND
  New evidence on the clinical effectiveness of acupuncture plus usual care (acupuncture) and counselling plus usual care (counselling) for patients with depression suggests the need to investigate the health-related quality of life and costs of these treatments to understand whether they should be considered a good use of limited health resources.
  
  
  RESULTS
  The cost-effectiveness analyses are based on the Acupuncture, Counselling or Usual care for Depression (ACUDep) trial results. Statistical analyses demonstrate a difference in mean quality adjusted life years (QALYs) and suggest differences in mean costs which are mainly due to the price of the interventions. Probabilistic sensitivity analysis is used to express decision uncertainty. Acupuncture and counselling are found to have higher mean QALYs and costs than usual care. In the base case analysis acupuncture has an incremental cost-effectiveness ratio (ICER) of £4,560 per additional QALY and is cost-effective with a probability of 0.62 at a cost-effectiveness threshold of £20,000 per QALY. Counselling compared with acupuncture is more effective and more costly with an ICER of £71,757 and a probability of being cost-effective of 0.36. A scenario analysis of counselling versus usual care, excluding acupuncture as a comparator, results in an ICER of £7,935 and a probability of 0.91.
  
  
  CONCLUSIONS
  Acupuncture is cost-effective compared with counselling or usual care alone, although the ranking of counselling and acupuncture depends on the relative cost of delivering these interventions. For patients in whom acupuncture is unavailable or perhaps inappropriate, counselling has an ICER less than most cost-effectiveness thresholds. However, further research is needed to determine the most cost-effective treatment pathways for depressed patients when the full range of available interventions is considered.
authors.affiliation: Centre for Health Economics, University of York, York, United Kingdom.
authors.forename: Eldon
authors.initials: E
authors.lastname: Spackman
authors.affiliation: Department of Health Sciences, University of York, York, United Kingdom.
authors.forename: Stewart
authors.initials: S
authors.lastname: Richmond
authors.affiliation: Centre for Health Economics, University of York, York, United Kingdom.
authors.forename: Mark
authors.initials: M
authors.lastname: Sculpher
authors.affiliation: Department of Health Sciences, University of York, York, United Kingdom.
authors.forename: Martin
authors.initials: M
authors.lastname: Bland
authors.affiliation: Department of Health Sciences, University of York, York, United Kingdom.
authors.forename: Stephen
authors.initials: S
authors.lastname: Brealey
authors.affiliation: Department of Health Sciences, University of York, York, United Kingdom.
authors.forename: Rhian
authors.initials: R
authors.lastname: Gabe
authors.affiliation: Department of Health Sciences, University of York, York, United Kingdom.
authors.forename: Ann
authors.initials: A
authors.lastname: Hopton
authors.affiliation: Department of Health Sciences, University of York, York, United Kingdom.
authors.forename: Ada
authors.initials: A
authors.lastname: Keding
authors.affiliation: Department of Health Sciences, University of York, York, United Kingdom.
authors.forename: Harriet
authors.initials: H
authors.lastname: Lansdown
authors.affiliation: Department of Health Sciences, University of York, York, United Kingdom.
authors.forename: Sara
authors.initials: S
authors.lastname: Perren
authors.affiliation: Department of Health Sciences, University of York, York, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Torgerson
authors.affiliation: Hull York Medical School, University of York, York, United Kingdom.
authors.forename: Ian
authors.initials: I
authors.lastname: Watt
authors.affiliation: Department of Health Sciences, University of York, York, United Kingdom.
authors.forename: Hugh
authors.initials: H
authors.lastname: MacPherson
mesh_terms: D015670:Acupuncture Therapy / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D003376:Counseling / Q000191:economics* / Q000379:methods; D003863:Depression / Q000191:economics / Q000628:therapy*; D003866:Depressive Disorder / Q000191:economics / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome