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

BMC Gastroenterology

David Torgerson¹  Sally Brabyn¹  Tracy Stuardi¹  Helen Tilbrook¹  Hugh MacPherson¹  Karen Bloor¹  Eugena Stamuli¹ 

[1] Department of Health Sciences, University of York, York, YO10 5DD, UK

关键词: Quality of life;    Health technology assessment;    Economic evaluation;    Irritable bowel syndrome;    Acupuncture;   

Others  :  858324
DOI  :  10.1186/1471-230X-12-149

 received in 2012-05-03, accepted in 2012-09-19,  发布年份 2012

【 摘 要 】

Background

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).

Methods

Cost-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.

Results

The 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.

Conclusions

Acupuncture 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 registration

Current Controlled Trials ISRCTN08827905

【 授权许可】

   
2012 Stamuli et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Rey E, Talley NJ: Irritable bowel syndrome: novel views on the epidemiology and potential risk factors. Digestive and Liver Disease 2009, 41:772-780.
• [2]Lea R, Whorwell PJ: Quality of life in irritable bowel syndrome. Pharmacoeconomics 2001, 19:643-653.
• [3]Akehurst RL, Brazier JE, Mathers N, O’Keefe C, Kaltenthaler E, et al.: Health-related quality of life and cost impact of irritable bowel syndrom in a UK primary care setting. Pharmacoeconomics 2002, 20:455-462.
• [4]Hahn BA, Kirchdoerfer LJ, Fullerton S, Mayer E: Patient-perceived severity of irritable bowel syndrome in relation to symptoms, health resource utilization and quality of life. Aliment Pharmacol Ther 1997., 11
• [5]Wells NEJ, Hahn BA, Whorwell PJ: Clinical economics review: irritable bowel syndrome. Aliment Pharmacol Ther 1997, 11:10119-11030.
• [6]Creed F, Ratcliffe J, Fernandez L, Tomenson B, Palmer S, et al.: Health-Related Quality of Life and Health Care Costs in Severe, Refractory Irritable Bowel Syndrome. Ann Intern Med 2001, 134:860-868.
• [7]Hahn B, Yan S, Strassels S: Impact of irritable bowel syndrome on quality of life and resource us in the United States and United Kingdom. Digestion 1999, 60:77-81.
• [8]Akehurst R, Kaltenthaler E: Treatment of irritable bowel syndrome: a review of randomised controlled trials. Gut 2001, 48:272-282.
• [9]Drossman DA, Whitehead WE, Camilleri M: Irritable bowel syndrome: a technical review for practice guideline development. Gastroenterology 1997, 112:2120-2137.
• [10]Lim B, Manheimer E, Lao L, Ziea E, Wisniewski J, Liu J, et al.: Acupuncture for treatment of irritable bowel syndrome. Cochrane Database Syst Rev 2006, 4:CD005111.
• [11]MacPherson H, Bland M, Bloor K, Cox H, Geddes D, Kang’ombe A, Reynolds J, Stamuli E, Stuardi T, Tilbrook H, et al.: Acupuncture for irritable bowel syndrome: a protocol for a pragmatic randomised controlled trial. BMC Gastroenterol 2010, 10:63.
• [12]MacPherson H, Tilbrook H, Bland JM, Bloor K, Brabyn S, Cox H, Kang’ombe AR, Man MS, Stuardi T, Torgerson D, Watt I, Whorwell P: Acupuncture for irritable bowel syndrome: primary care based pragmatic randomised controlled trial. BMC Gastroenterology 2012, 12:139.
• [13]MacPherson H, et al.: Acupuncture for irritable bowel syndrome: primary care based pragmatic randomised controlled trial. BMC Gastroenterology 2012, 12:150.
• [14]National Institute for Health and Clinical Excellence: Guide to the methods of technology appraisal. http://wwwniceorguk/media/B52/A7/TAMethodsGuideUpdatedJune2008pdf webcite 2008
• [15]Kind P: EuroQol instrument: an index of health-related quality of life. In Quality of life and pharmacoeconomics in clinical trials. Edited by Spilker B. Philadelphia: Lippincott-Raven; 1996.
• [16]Dolan P, Gudex C, Kind P, Williams A: A social tarif for EuroQol: Results from a UK general population survey. University of York: York; 1995. [Discussion Paper No 138, Centre for Health Economics]
• [17]Curtis L: Unit Costs of Health and Social Care. 2010,  . http://wwwpssruacuk/pdf/uc/uc2010/uc2010pdf webcite 2010
• [18]NHS reference cost 2009–2010: NHS trust and PCT combined reference costs schedules.   . http://wwwdhgovuk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_123459 webcite
• [19]NHS choices website:  . . http://wwwnhsuk/Conditions/Acupuncture/Pages/Introductionaspx webcite Accessed February 2011
• [20]Manca A, Hawkins N, Sculpher MJ: Estimating mean QALYs in trial-based cost-effectivenessanalysis: the importance of controlling for baseline utility. Health Econ 2005, 14:487-496.
• [21]Francis CY, Morris J, Whorwell PJ: The irritable bowel severity scoring system: a simple method of monitoring irritable bowel syndrome and its progress. Aliment Pharmacol Ther 1997, 11:395-402.
• [22]Gralnek IM, Hays RD, Kilbourne A, Naliboff B, Mayer EA: The impact of irritable bowel syndrome on health-related quality of life. Gastroenterology 2000, 119:654-660.
• [23]Miller V, Hopkins L, Whorwell PJ: Suicidal ideation in patients with irritable bowel syndrome. Clin Gastroenterol Hepatol 2004, 2:1064-1068.