Economic analysis of complementary, alternative, and integrative medicine: considerations raised by an expert panel

BMC Complementary and Alternative Medicine

Shanthi Nataraj¹  Patricia M Herman³  Ian D Coulter² 

[1] Health Unit, RAND Corporation, Santa Monica, CA, USA;RAND/Samueli Chair for Integrative Medicine, Santa Monica, CA, USA;Samueli Institute, Alexandria, VA, USA

关键词: Economic evaluation;    Integrative medicine;    Complementary and alternative medicine;   

Others  :  1221055
DOI  :  10.1186/1472-6882-13-191

 received in 2013-01-23, accepted in 2013-07-23,  发布年份 2013

【 摘 要 】

Background

An international panel of experts was convened to examine the challenges faced in conducting economic analyses of Complementary, Alternative and Integrative Medicine (CAIM).

Methods

A one and a half-day panel of experts was convened in early 2011 to discuss what was needed to bring about robust economic analysis of CAIM. The goals of the expert panel were to review the current state of the science of economic evaluations in health, and to discuss the issues involved in applying these methods to CAIM, recognizing its unique characteristics. The panel proceedings were audiotaped and a thematic analysis was conducted independently by two researchers. The results were then discussed and differences resolved. This manuscript summarizes the discussions held by the panel members on each theme.

Results

The panel identified seven major themes regarding economic evaluation that are particularly salient to determining the economics of CAIM: standardization (in order to compare CAIM with conventional therapies, the same basic economic evaluation methods and framework must be used); identifying the question being asked, the audience targeted for the results and whose perspective is being used (e.g., the patient perspective is especially relevant to CAIM because of the high level of self-referral and out-of-pocket payment); the analytic methods to be used (e.g., the importance of treatment description and fidelity); the outcomes to be measured (e.g., it is important to consider a broad range of outcomes, particularly for CAIM therapies, which often treat the whole person rather than a specific symptom or disease); costs (e.g., again because of treating the whole person, the impact of CAIM on overall healthcare costs, rather than only disease-specific costs, should be measured); implementation (e.g., highlighting studies where CAIM allows cost savings may help offset its image as an “add on” cost); and generalizability (e.g., proper reporting can enable study results to be useful beyond the study sample).

Conclusions

The business case for CAIM depends on economic analysis and standard methods for conducting such economic evaluations exist. The challenge for CAIM lies in appropriately applying these methods. The deliberations of this panel provide a list of factors to be considered in meeting that challenge.

【 授权许可】

   
2013 Coulter et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Pelletier KR, Herman PM, Metz RD, Nelson CF: Health and medical economics: applications to integrative medicine. In Commissioned for summit on integrative medicine and the health of the public. Washington, DC: Institute of Medicine; 2009.
• [2]Drummond MF, Sculpher MJ, Torrance GW, O’Brien BJ, Stoddart GL: Methods for the economic evaluation of health care programmes. Third edition. Oxford: Oxford University Press; 2005.
• [3]Gunter MJ: The role of the ECHO model in outcomes research and clinical practice improvement. Am J Managed Care 1999, 5(4 Suppl):S217-S224.
• [4]Prieto L, Sacristán JA: Problems and solutions in calculating quality-adjusted life years (QALYs). Health Qual Life Outcomes 2003, 1(80):1-8.
• [5]Herman PM: Evaluating the economics of complementary and integrative medicine. Alexandria, VA: Samueli Institute; 2012.
• [6]Garrison LP, Mansley EC, Abbott TA, Bresnahan BW, Hay JW, Smeeding J: Good research practices for measuring drug costs in cost-effectiveness analyses: a societal perspective: the ISPOR drug cost task force report—part II. Value Health 2010, 13(1):8-13.
• [7]Neumann PJ: Costing and perspective in published cost-effectiveness analysis. Med Care 2009, 47(Suppl 1):S28-S32.
• [8]Hasson H: Systematic evaluation of implementation fidelity of complex interventions in health and social care. Implement Sci 2010, 5:67. BioMed Central Full Text
• [9]Coulter I: Comparative effectiveness research: does the emperor have clothes? Altern Ther Health Med 2011, 17:8-15.
• [10]Cassidy CM: Social science theory and methods in the study of alternative and complementary medicine. J Altern Complement Med 1995, 2:19-40.
• [11]Mason S, Tovey P, Long AF: Evaluating complementary medicine: methodological challenges of randomised controlled trials. BMJ 2002, 325:832-834.
• [12]Nahin RL, Strauss SE: Research into complementary and alternative medicine: problems and potential. BMJ 2001, 322:161-164.
• [13]Tonelli MR, Callahan TC: Why alternative medicine cannot be evidence-based. Acad Med 2001, 76:1213-1220.
• [14]Gold MR, Siegel JE, Russell LB, Weinstein MC (Eds): Cost-effectiveness in health and medicine. New York: Oxford University Press; 1996.
• [15]Luce BR, Kramer JM, Goodman SN, Connor JT, Tunis S, Whicher D, Schwartz JS: Rethinking randomized clinical trials for comparative effectiveness research: the need for transformational change. Annals Intern Med 2009, 151(3):206-209.
• [16]Sox HC, Greenfield S: Comparative effectiveness research: a report from the institute of medicine. Annals Intern Med 2009, 151(3):203.
• [17]Thorpe KE, Zwarenstein M, Oxman AD, Treweek S, Furberg CD, Altman DG, Tunis S, Bergel E, Harvey I, Magid DJ, et al.: A pragmatic-explanatory continuum indicator summary (PRECIS): a tool to help trial designers. J Clin Epidemiol 2009, 62:464-475.
• [18]Tunis SR, Stryer DB, Clancy CM: Practical clinical trials: increasing the value of clinical research for decision making in clinical and health policy. JAMA 2003, 290(12):1624-1632.
• [19]Witt CM: Efficacy, effectiveness, pragmatic trials–guidance on terminology and the advantages of pragmatic trials. Forsch Komplementarmed 2009, 16(5):292-294.
• [20]Herman PM, Poindexter BL, Witt CM, Eisenberg DM: Are complementary therapies and integrative care cost-effective? a systematic review of economic evaluations. BMJ Open 2012., 2(5)
• [21]Herman WH, Hoerger TJ, Brandle M, Hicks K, Sorensen S, Zhang P, Hamman RF, Ackermann RT, Engelgau MM, Ratner RE: The cost-effectiveness of lifestyle modification or metformin in preventing type 2 diabetes in adults with impaired glucose tolerance. Annals Intern Med 2005, 142(5):323.
• [22]Briggs A, Claxton K, Sculpher M: Decision modelling for health economic evaluation. Oxford: Oxford University Press; 2006.
• [23]Donaldson C, Shackley P: Does “process utility” exist? A case study of willingness to pay for laparoscopic cholecystectomy. Soc Sci Med 1997, 44(5):699-707.
• [24]Meenan R: Developing appropriate measures of the benefits of complementary and alternative medicine. J Health Serv Res Policy 2001, 6(1):38-43.
• [25]Green PE, Srinivasan V: Conjoint analysis in marketing: new developments with implications for research and practice. J Marketing 1990, 54(4):3-19.
• [26]The EuroQoL Group: EuroQoL - a new facility for the measurement of health-related quality of life. Health Policy 1990, 16:199-208.
• [27]Brazier J, Roberts J, Deverill M: The estimation of a preference-based measure of health from the SF-36. J Health Econ 2002, 21:271-292.
• [28]Brazier JE, Roberts J: The estimation of a preference-based measure of health from the SF-12. Med Care 2004, 42:851-859.
• [29]Brazier J, Roberts J, Tsuchiya A, Busschbach J: A comparison of the EQ-5D and SF-6D across seven patient groups. Health Econ 2004, 13:873-884.
• [30]Bonomi AE, Fishman PA, Boudreau DM, Meenan RT, Revicki D: Family-level cost-effectiveness analysis: response to Holmes’ commentary. Qual Life Res 2005, 14(4):1139-1140.
• [31]Mauskopf JA, Paul JE, Grant DM, Stergachis A: The role of cost-consequence analysis in healthcare decision-making. Pharmacoeconomics 1998, 13(3):277-288.
• [32]Berger ML, Bingefors K, Hedblom EC, Pashos CL, Torrance GW, Smith MD (Eds): Health care cost, quality, and outcomes: ISPOR book of terms. Lawrencevill, NJ: International Society for Pharmacoeconomics and Outcomes Research; 2003.
• [33]Dzator J, Hendrie D, Burke V, Gianguilio N, Gillam H, Beilin L, Houghton S: A randomized trial of interactive group sessions achieved greater improvements in nutrition and physical activity at a tiny increase in cost. J Clin Epidemiol 2004, 57(6):610-619.
• [34]Long AF: Outcome measurement in complementary and alternative medicine: unpicking the effects. J Altern Complement Med 2002, 8(6):777-786.
• [35]O’Sullivan AK, Thompson D, Drummond MF: Collection of health-economic data alongside clinical trials: is there a future for piggyback evaluations? Value Health 2005, 8(1):67-79.
• [36]Economics A: Cost effectiveness of complementary medicines. South Penrith, DC, Australia: National Institute of Complementary Medicine; 2010.
• [37]Weinstein MC, Siegel JE, Gold MR, Kamlet MS, Russell LB: Recommendations of the panel on cost-effectiveness in health and medicine. JAMA 1996, 276(15):1253-1258.
• [38]Colloca L, Miller FG: Role of expectations in health. Curr Opin Psychiatry 2011, 24(2):149-155.
• [39]Young J, Tschudi P, Périat P, Hugenschmidt C, Welge-Lüssen A, Bucher H: Patients’ Expectations about the benefit of XAntibiotic treatment: lessons from a randomised controlled trial. Forsch Komplementmed/Res Complement Med 2005, 12(6):347-349.
• [40]Launsø L, Henningsen I, Rieper J, Brender H, Sandø F, Hvenegaard A: Expectations and effectiveness of medical treatment and classical homeopathic treatment for patients with hypersensitivity illnesses–one year prospective study. Homeopathy: J Fac Homeopathy 2007, 96(4):233.
• [41]Linde K, Witt CM, Streng A, Weidenhammer W, Wagenpfeil S, Brinkhaus B, Willich SN, Melchart D: The impact of patient expectations on outcomes in four randomized controlled trials of acupuncture in patients with chronic pain. Pain 2007, 128(3):264-271.
• [42]Little CV: Patient expectations of ‘effectiveness’ in health care: an example from medical herbalism. J Clin Nurs 2012, 21(5–6):718-727.
• [43]Drummond M, Manca A, Sculpher M: Increasing the generalizability of economic evaluations: recommendations for the design, analysis, and reporting of studies. Int J Technol Assess Health Care 2005, 21(2):165-171.
• [44]Drummond M, Barbieri M, Cook J, Glick HA, Lis J, Malik F, Reed SD, Rutten F, Sculpher M, Severens J: Transferability of economic evaluations across jurisdictions: ISPOR good research practices task force report. Value Health 2009, 12(4):409-418.
• [45]Sculpher MJ, Pang FS, Manca A, Drummond MF, Golder S, Urdahl H, et al.: Generalisability in economic evaluation studies in healthcare: a review and case studies. Health Technol Assess 2004, 8(49):1-192.
• [46]Bonsel GJ, Rutten FFH, Uyl-de Groot CA: Economic evaluation alongside cancer trials: methodological and practical aspects. Eur J Cancer 1993, 29A(Suppl 7):S10-S14.
• [47]Drummond MF, Davies L: Economic analysis alongside clinical trials: revisiting the methodological issues. Int J Technol Assess Health Care 1991, 7(4):561-573.
• [48]Beckman JF, Fernandez CE, Coulter ID: A systems model of health care: a proposal. J Manipulative Physiol Ther 1996, 19(3):208.
• [49]Bell IR, Caspi O, Schwartz GER, Grant KL, Gaudet TW, Rychener D, Maizes V, Weil A: Integrative medicine and systemic outcomes research: issues in the emergence of a new model for primary health care. Arch Intern Med 2002, 162(2):133.
• [50]Ritenbaugh C, Verhoef M, Fleishman S, Boon H, Leis A: Whole systems research: a discipline for studying complementary and alternative medicine. Altern Ther Health Med 2003, 9(4):32.
• [51]Verhoef MJ, Lewith G, Ritenbaugh C, Boon H, Fleishman S, Leis A: Complementary and alternative medicine whole systems research: beyond identification of inadequacies of the RCT. Complement Ther Med 2005, 13(3):206.
• [52]Horrigan B, Lewis S, Abrams D, Pechura C: Integrative medicine in America: How integrative medicine is being practiced in clinical centers across the United States. Minneapolis, MN: The Bravewell Collaborative; 2012.