Abstract
ObjectiveTo assess the cost-effectiveness of acupuncture for pelvic girdle and low back pain (PGLBP) during pregnancy.DesignPragmatic-open-label randomised controlled trial.SettingFive maternity hospitalsPopulationPregnant women with PGLBPMethod1:1 randomization to standard care or standard care plus acupuncture (5 sessions by an acupuncturist midwife).Main outcome measureEfficacy: proportion of days with self-assessed pain by numerical rating scale (NRS) ≤ 4/10. Cost effectiveness (societal viewpoint, time horizon: pregnancy): incremental cost per days with NRS ≤ 4/10. Indirect non-healthcare costs included daily compensations for sick leave and productivity loss caused by absenteeism or presenteeism.Results96 women were allocated to acupuncture and 103 to standard care (total 199). The proportion of days with NRS ≤ 4/10 was greater in the acupuncture group than in the standard care group (61% vs 48%, p = 0.007). The mean Oswestry disability score was lower in the acupuncture group than with standard care alone (33 versus 38, Δ = 5, 95% CI: 0.8 to 9, p = 0.02). Average total costs were higher in the control group (€2947) than in the acupuncture group (€2635, Δ = —€312, 95% CI: -966 to +325), resulting from the higher indirect costs of absenteeism and presenteeism. Acupuncture was a dominant strategy when both healthcare and non-healthcare costs were included. Costs for the health system (employer and out-of-pocket costs excluded) were slightly higher for acupuncture (€1512 versus €1452, Δ = €60, 95% CI: -272 to +470).ConclusionAcupuncture was a dominant strategy when accounting for employer costs. A 100% probability of cost-effectiveness was obtained for a willingness to pay of €100 per days with pain NRS ≤ 4.
Highlights
Pelvic girdle and low back pain (PGLBP) is common during pregnancy affecting 5 to 76% of pregnant women, depending on clinical definition[1,2,3,4]
The mean Oswestry disability score was lower in the acupuncture group than with standard care alone (33 versus 38, Δ = 5, 95% confidence intervals (95% CI): 0.8 to 9, p = 0.02)
Average total costs were higher in the control group (€2947) than in the acupuncture group (€2635, Δ = —€312, 95% CI: -966 to +325), resulting from the higher indirect costs of absenteeism and presenteeism
Summary
Pelvic girdle and low back pain (PGLBP) is common during pregnancy affecting 5 to 76% of pregnant women, depending on clinical definition[1,2,3,4]. PGLBP is characterized by pain between the posterior iliac crest and the gluteal fold, in the vicinity of the sacroiliac joints (SIJ) or in the lumbar region above the sacrum[5,6]. Previous low back or pelvic girdle pain and weight gain during pregnancy are risk factors[6,7]. Pain increases with standing position and physical activity. Diagnosis relies on analysing functional complaints and performing basic pain provocation tests[5,6,8]. Symptoms tend to disappear after delivery, but may continue up to 3 years in about 20% of women[9]
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