Cost-Effectiveness Analysis of Acupuncture, Counselling and Usual Care in Treating Patients with Depression: The Results of the ACUDep Trial

Abstract

BackgroundNew evidence on the clinical effectiveness of acupuncture plus usual care (acupuncture) and counselling plus usual care (counselling) for patients with depression suggests the need to investigate the health-related quality of life and costs of these treatments to understand whether they should be considered a good use of limited health resources.Methods and FindingsThe cost-effectiveness analyses are based on the Acupuncture, Counselling or Usual care for Depression (ACUDep) trial results. Statistical analyses demonstrate a difference in mean quality adjusted life years (QALYs) and suggest differences in mean costs which are mainly due to the price of the interventions. Probabilistic sensitivity analysis is used to express decision uncertainty. Acupuncture and counselling are found to have higher mean QALYs and costs than usual care. In the base case analysis acupuncture has an incremental cost-effectiveness ratio (ICER) of £4,560 per additional QALY and is cost-effective with a probability of 0.62 at a cost-effectiveness threshold of £20,000 per QALY. Counselling compared with acupuncture is more effective and more costly with an ICER of £71,757 and a probability of being cost-effective of 0.36. A scenario analysis of counselling versus usual care, excluding acupuncture as a comparator, results in an ICER of £7,935 and a probability of 0.91.ConclusionsAcupuncture is cost-effective compared with counselling or usual care alone, although the ranking of counselling and acupuncture depends on the relative cost of delivering these interventions. For patients in whom acupuncture is unavailable or perhaps inappropriate, counselling has an ICER less than most cost-effectiveness thresholds. However, further research is needed to determine the most cost-effective treatment pathways for depressed patients when the full range of available interventions is considered.

Descriptive Cost-Effectiveness Analysis of a Counseling and Coordination Model in Psychosocial Care. Integration of Health Care and Social Rehabilitation

“…Compared to other studies on the cost-effectiveness of psychosocial and psychiatric interventions the gain in quality of life of 0.0568 QALYs in the present study can be classified into the upper range. Out of eleven international publications on psychosocial interventions, only two have reported an increase of more than 0.06 quality-adjusted life-years (33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43). Regarding the incremental expenditure per QALY, additional costs [ranging from 386 € (33) to 53,717 (42)] incurred in each of these studies, which would accordingly apply to an upper right hand quadrant in the cost-effectiveness plane (higher quality of life and higher costs; cost-effectiveness calculations required).…”

Descripción del costo en medicamentos en pacientes atendidos en una unidad de atención en medicina complementaria: estudio preliminar

“…En Korea, Kim et al (19) determinaron que los costos directos de un programa de acupuntura para el manejo de las lumbalgias crónicas costaba un promedio de USD 231 por tres meses. Este método tambien ha demostrado ser costo-efectivo en el manejo de la depresión (20) y migraña (21) . …”

Using economic evaluations to support acupuncture reimbursement decisions: current evidence and gaps

“…Most of the existing economic evaluations of acupuncture have been conducted in Germany, 12 13 14 20 the UK, 12 13 14 21 22 23 and the US, 24 25 26 each of which has its unique health system, costs, clinical practice, and population health preferences. Therefore, it is difficult to generalise the results to other countries.…”