Abstract
The National Institute for Health and Clinical Excellence (NICE) finds it difficult to understand acupuncture controls. As readers may recall, we were somewhat exercised by the NICE guidelines on osteoarthritis in 2008.1–3 NICE calculated the cost-effectiveness of acupuncture by comparing it with sham acupuncture. We argue that cost-effectiveness comparisons are only useful in making a decision about treatment if they compare treatments that are actually available. Therefore, they should have compared acupuncture with usual care, as they did with back pain.2 Recently, Latimer and colleagues4 showed what a dramatic difference it makes which control you select: acupuncture for osteoarthritis is clearly cost-effective against usual care, but not against sham acupuncture. NICE …
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