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

Research Article

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

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

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

DOI  :  10.1186/1471-230X-12-149

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

来源: Springer

【 摘 要 】

BackgroundThere 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).MethodsCost-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.ResultsThe 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.ConclusionsAcupuncture 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 registrationCurrent Controlled Trials ISRCTN08827905

【 授权许可】

CC BY   
© Stamuli et al.; licensee BioMed Central Ltd. 2012