Cost-effectiveness of acupuncture for irritable bowel syndrome: findings from an economic evaluation conducted alongside a pragmatic randomised controlled trial in primary care

Eugena Stamuli,Sally Brabyn,Tracy Stuardi,Karen Bloor,David Torgerson,Hugh Macpherson,Helen Tilbrook

doi:10.1186/1471-230x-12-149

Eugena Stamuli, Sally Brabyn + Show 5 more

Open Access

https://doi.org/10.1186/1471-230x-12-149

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Journal: BMC Gastroenterology	Publication Date: Oct 24, 2012
Citations: 30	License type: CC BY 2.0

Affiliation: University of York

Abstract

BackgroundThere 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).MethodsCost-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.ResultsThe 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.ConclusionsAcupuncture 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.Trial registrationCurrent Controlled Trials ISRCTN08827905

Highlights

There is insufficient evidence to determine whether acupuncture is a cost-effective treatment for irritable bowel syndrome
This paper reports the relative costeffectiveness of acupuncture for Irritable Bowel Syndrome (IBS), assessed as part of a pragmatic randomized controlled trial undertaken in the UK [11,12]
233 participants were recruited from primary care in the English NHS into a pragmatic randomised controlled trial of acupuncture for IBS. were randomised to receive a short course of traditional acupuncture plus usual GP care and to receive usual GP care alone

Summary

Introduction

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). The main symptoms are abdominal pain or discomfort, altered form, frequency and passage of stools, and abdominal distension. The disease is not life-threatening, but leads to significant impairment of health related quality of life, which reflects physical role limitations as well as pain and a lower perception of general health [2]. IBS causes high level of absenteeism and impairs workplace functioning; the magnitude of impairment is directly related to severity and frequency of bowel symptoms [4]

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