Cost-effectiveness of acupuncture versus standard care for pelvic and low back pain in pregnancy: A randomized controlled trial

Abstract

Objective To assess the cost-effectiveness of acupuncture for pelvic girdle and low back pain (PGLBP) during pregnancy. Design Pragmatic-open-label randomised controlled trial. Setting Five maternity hospitals Population Pregnant women with PGLBP Method 1:1 randomization to standard care or standard care plus acupuncture (5 sessions by an acupuncturist midwife). Main outcome measure Efficacy: proportion of days with self-assessed pain by numerical rating scale (NRS) ≤ 4/10. Cost effectiveness (societal viewpoint, time horizon: pregnancy): incremental cost per days with NRS ≤ 4/10. Indirect non-healthcare costs included daily compensations for sick leave and productivity loss caused by absenteeism or presenteeism. Results 96 women were allocated to acupuncture and 103 to standard care (total 199). The proportion of days with NRS ≤ 4/10 was greater in the acupuncture group than in the standard care group (61% vs 48%, p = 0.007). The mean Oswestry disability score was lower in the acupuncture group than with standard care alone (33 versus 38, Δ = 5, 95% CI: 0.8 to 9, p = 0.02). Average total costs were higher in the control group (€2947) than in the acupuncture group (€2635, Δ = —€312, 95% CI: -966 to +325), resulting from the higher indirect costs of absenteeism and presenteeism. Acupuncture was a dominant strategy when both healthcare and non-healthcare costs were included. Costs for the health system (employer and out-of-pocket costs excluded) were slightly higher for acupuncture (€1512 versus €1452, Δ = €60, 95% CI: -272 to +470). Conclusion Acupuncture was a dominant strategy when accounting for employer costs. A 100% probability of cost-effectiveness was obtained for a willingness to pay of €100 per days with pain NRS ≤ 4.

Pain and Opioid Use: Evidence for Integrating Acupuncture Into Treatment Planning

“…Cost effectiveness of acupuncture as an adjuvant care was also demonstrated in a study examining treatment for women experiencing low back pain associated with pregnancy. 21 In this randomized controlled study, the average total costs in the group receiving standard treatment alone were higher than those for the group receiving standard care plus acupuncture indicating the benefits of adding acupuncture to standard care.…”

Pragmatic trials of pain therapies: a systematic review of methods

“…The primary time point at which outcomes were measured was a median of 26 weeks postrandomization (Q1/3: 8; 52 weeks; n = 36) ranging from a single day 104 to 5 years. 6 However, there were many studies that assessed outcomes over a period, 5 , 9 , 30 , 34 , 97 , 102 , 106 at flexible time points, 50 , 81 , 108 studies that defined several time points as primary, 75 , 111 and several that did not specify a primary point of follow-up. 3 , 8 , 26 , 59 , 66 , 83 , 109 , 122 A better indicator for how long self-declared pragmatic trials are, may thus be the longest time point of follow-up, for which the median was about one year after randomization (median 50 weeks, Q1/3; 23.25; 52 weeks; n = 56; not reported in one case 50 ).…”

“…Across our sample of included studies, there was a significant difference in attrition between groups (t(56) = 7.16, P < 0.001) and a third of studies reported differential attrition (19; 33%, n = 57). Where there was differential attrition, it was almost as often into the direction of the control group (9 cases 5 , 16 , 81 , 84 , 97 , 101 , 117 , 127 ) as it was into the direction of the intervention group (11 cases 7 , 9 , 20 , 67 , 81 , 82 , 85 , 87 , 94 , 111 , 118 , 123 ), with intervention groups losing an average of 14.9% (SD 12.9) and control groups losing an average of 14.8% (SD 12.8) of participants until the point of primary follow-up (t(112) = 0.032, P = 0.97), possibly accounting for the fact that both groups were of active interventions in most cases.…”

“…Harms did occur in 22 of those studies, and in 9 of those trials, there was a significant difference between groups. 23 , 63 , 71 , 81 , 84 , 94 , 95 , 97 , 127 …”

Cost-effectiveness analysis of acupuncture compared with usual care for acute non-specific low back pain: secondary analysis of a randomised controlled trial

“…12,13 In a systematic review by Andronis et al, 12 acupuncture for chronic LBP was found to be likely cost-effective; however, to our knowledge, no previous trials of acupuncture for ALBP have evaluated the cost-effectiveness of the treatment. One RCT reported by Nicolian et al 14 found acupuncture and usual care to be less costly and more effective than usual care alone in the treatment of pelvic pain and LBP in pregnancy.…”