Abstract
Pelvic girdle and low back pain (PGLBP) is a common condition during pregnancy, resulting in poor functional score and quality of life. Its economic burden is mostly explained by indirect non-healthcare costs caused by work-time lost. Our objective was to assess the cost-effectiveness of acupuncture care services for PGLBP during pregnancy. The GAME pragmatic-open-label trial randomized 1:1 pregnant women with PGLBP from five Paris region maternity between 2012 and 2014 to receive standard care or standard care plus acupuncture (5 sessions performed by an acupuncturist midwife). The primary efficacy outcome was proportion of days with self-assessed pain <4/10. The main cost effectiveness outcome was incremental cost per day without pain. Indirect non-healthcare costs included daily compensations for sick leave and productivity loss caused by absenteeism or presenteeism. 96 patients were allocated to acupuncture and 104 to standard care, with no differences in baseline characteristics. The proportion of days without pain was higher in the acupuncture group than in the standard care group (61% vs 48%, Δ=12.9%, IC95=3.6;22.1, p<0.001). The mean Oswestry disability score between baseline and delivery was lower in acupuncture group against control (33 vs 38, Δ=4.9, IC95=0.7;8.8, p=0.02). Average total costs were higher in the control group (€5,320 vs €4,818, Δ=€502, IC95: €-1,113;€2,160), mostly explained by the indirect costs of absenteeism and presenteeism. Health system and patient out-of-pocket costs (employer cost excluded) were slightly higher for acupuncture (€2,913 vs €2,807, Δ=€106, IC95=€-702; €959). Acupuncture was a dominant strategy when accounting for employer costs and a 100% probability of cost-effectiveness was obtained for a willingness to pay of 150€ per day without pain. Acupuncture plus routine care is cost-effective from a societal perspective. This open and pragmatic study does not aim to estimate the isolated effectiveness of acupuncture but its impact on healthcare resource use.
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