Cost-effectiveness analysis of acupuncture compared with usual care for acute non-specific low back pain: secondary analysis of a randomised controlled trial.

Trygve Skonnord,Holgeir Skjeie,Atle Klovning,Mette Brekke,Eline Aas,Margreth Grotle,Arne Fetveit

doi:10.1177/09645284211055747

Abstract

Objective:To assess the cost-effectiveness of a single treatment session of acupuncture, when applied in addition to usual care for acute low back pain (ALBP).Methods:Secondary analysis of a multicentre randomised controlled trial in Norwegian general practice. In total, 171 participants with ALBP ⩽14 days were randomised to a control group (CG) receiving usual care or to an acupuncture group (AG) receiving one additional session of Western medical acupuncture alongside usual care. Primary outcome measures for this cost-effectiveness analysis were quality-adjusted life years (QALYs), health care costs and societal costs at days 28 and 365, the incremental cost-effectiveness ratio (ICER) and net monetary benefit (NMB). The NMB was calculated on the basis of the Norwegian cost-effectiveness threshold of NOK 275,000 (USD 35,628) per QALY gained. Missing data were replaced by multiple chained imputation.Results:Eighty-six participants in the CG and 81 in the AG were included in the analysis. We found no QALY gain at day 28. At day 365, the incremental QALY of 0.035 was statistically significant. The differences in health care costs and societal costs were not statistically significant. Three out of four calculations led to negative ICERs (cost saving) and positive NMBs. For the health care perspective at day 365, the ICER was USD –568 per QALY and the NMB was USD 1265, with 95.9% probability of acupuncture being cost-effective.Conclusion:To our knowledge, this is the first cost-effectiveness analysis of acupuncture for ALBP. The findings indicate that acupuncture may be cost-effective from a 1-year perspective, but more studies are needed.Trial registration number:NCT01439412 (ClinicalTrials.gov).

Highlights

Low back pain (LBP) is a major cause of disability.[1,2] Most episodes of LBP are classified as non-specific, and most affected patients recover within 1 month.[1,3] as LBP is very common and many people experience recurrences or develop chronic pain, the burden for each patient and the costs for society are significant.[1,2] These costs can be reported as health care costs and societal costs, due to absence from work or loss of productivity.The treatment of acute low back pain (ALBP) usually takes place in primary health care and consists of information and education to avoid bed rest and to stay active.[4]
The present study aimed to evaluate whether a single treatment session of acupuncture for ALBP, when applied in addition to usual care, was cost-effective compared with usual care alone
We added one acupuncture treatment to usual care for patients with ALBP compared with usual care alone

Summary

Introduction

Low back pain (LBP) is a major cause of disability.[1,2] Most episodes of LBP are classified as non-specific, and most affected patients recover within 1 month.[1,3] as LBP is very common and many people experience recurrences or develop chronic pain, the burden for each patient and the costs for society are significant.[1,2] These costs can be reported as health care costs and societal costs, due to absence from work or loss of productivity.The treatment of acute low back pain (ALBP) usually takes place in primary health care and consists of information and education to avoid bed rest and to stay active.[4]. For chronic LBP, acupuncture has been shown to reduce pain and improve function in the short term compared with no treatment.[8,9,10] there is insufficient evidence for the use of acupuncture in ALBP.[8,9] Recently, we published the results of a multicentre randomised controlled trial (RCT) studying the effectiveness of adding acupuncture to usual care for ALBP.[11] We did not find a statistically significant difference between the group receiving acupuncture and usual care (AG), and the control group (CG) that only received usual care, in measures of time to recovery (primary outcome), disability, absence from work and health-related quality of life (HRQoL). The small, statistically significant differences in the secondary outcomes of pain, global improvement and medication were not considered clinically relevant.[11]

Methods

Results

Discussion

Conclusion