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Is acupuncture cost effective for chronic headache?

American Family Physician, Jan 15, 2005 by Anne D. Walling

Chronic headaches such as migraine and tension headaches are responsible for significant direct health care costs and even larger indirect costs because of lost productivity and burdens on patients and families. Acupuncture has been proposed as an alternative treatment for chronic headaches, but the cost effectiveness of this approach has not been determined. Wonderling and colleagues studied more than 400 patients recruited from general practices in England and Wales to determine the efficacy and costs of acupuncture for chronic headache.

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Patients who reported at least two headaches per month were assigned randomly to usual care or up to 12 acupuncture treatments over a three-month period. Data were gathered on the type and severity of headaches, as well as demographic information and costs paid by the patient for headache management. Patients completed a standardized measure of health-related quality of life at baseline, and three and 12 months after starting the study.

At baseline, the 136 patients assigned to acupuncture were similar to the 119 patients assigned to usual care in all important variables. Eighteen patients did not attend their acupuncture sessions. The remaining patients had an average of 4.2 hours of acupuncture therapy. Thirty patients assigned to acupuncture and two patients in the control group visited an acupuncturist for additional treatment during the study. Patients assigned to the acupuncture group showed a statistically significant improvement in health over the year and had small but significant reductions in physician visits and use of complementary or alternative medications. The total costs were higher in the acupuncture group because of acupuncture practitioners' costs. The researchers calculated the additional cost for each quality-adjusted life year (QALY) gained from acupuncture to be just over $16,300.

The authors conclude that acupuncture for chronic headache is relatively cost effective and compares favorably with the approximately $28,400 estimated cost of oral caffeine plus ergotamine.

ANNE D. WALLING, M.D.

Wonderling D, et al. Cost effectiveness analysis of a randomised trial of acupuncture for chronic headache in primary care. BMJ March 15, 2004;328:747-9.

EDITOR'S NOTE: Both the National Institutes of Health and the Cochrane Database reviews provide cautious support for acupuncture treatment of headache (predominantly migraine). In a condition with approximately 25 percent placebo response, a significant benefit from acupuncture could be anticipated, hence both organizations call for large, rigorously controlled trials to establish proof of benefit beyond the placebo response. (1) If acupuncture is beneficial, the cost-effectiveness calculations in the United States could be complicated because of the many headache medications available and a complex pricing structure. The comment in this article that changing from oral caffeine and ergotamine to suma triptan had a cost per QALY gained of more than $28,000 highlights the enormous costs of migraine medication. It also reminds me of an excellent study (2) in which properly dosed aspirin plus metoclopramide was equivalent, if not superior, to sumatriptan in acute migraine, and presumably much more cost effective. Migraine is an idiosyncratic condition in which the most cost-effective regimen is the one that works best for the individual patient.--A.D.W.

REFERENCES

(1.) Zoorob R, Morelli V, Larzelere M. Complementary and alternative medicine. AAFP home study self-assessment; FP essentials 293. Leawood, Kan.: American Academy of Family Physicians, 2003.

(2.) Tfelt-Hansen P, Henry P, Mulder LJ, Scheldewaert RG, Schoenen J, Chazot G. The effectiveness of combined oral lysine acetylsalicylate and metoclopramide compared with oral sumatriptan for migraine. Lancet 1995;346:923-6.

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Is acupuncture cost effective for chronic headache?

American Family Physician, Jan 15, 2005 by Anne D. Walling

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