White A R, Ernst E
Department of Complementary Medicine, School of Postgraduate Medicine and Health Sciences, University of Exeter, Exeter, UK.
Complement Ther Med. 2000 Jun;8(2):111-8. doi: 10.1054/ctim.2000.0356.
To review systematically all reports of economic analysis of complementary and alternative medicine.
Searches were performed in Medline, Embase and AMED for reports of cost description, cost comparison, cost effectiveness, or cost benefit studies. Prospective studies that investigated comparative groups were considered to be of higher quality.
A total of 34 reports was included. Retrospective studies in which a range of therapies are provided in primary care suggest that these may reduce referral and treatment costs, but prospective studies suggest that complementary medicine is an additional expense and does not substitute for orthodox care. For individual therapies, one thorough but retrospective study suggests that carefully targeted acupuncture may reduce referral costs for musculoskeletal problems. One large pragmatic study of spinal manipulative therapy suggests that this treatment may reduce the societal costs of back pain, but four controlled trials found that manipulative therapy does not reduce the costs incurred by the back pain patients themselves or by their health insurance provider.
Spinal manipulative therapy for back pain may offer cost savings to society, but it does not save money for the purchaser. There is a paucity of rigorous studies that could provide conclusive evidence of differences in costs and outcomes between other complementary therapies and orthodox medicine. The evidence from methodologically flawed studies is contradicted by more rigorous studies, and there is a need for high quality investigations of the costs and benefits of complementary medicine.
系统回顾所有补充和替代医学的经济分析报告。
在Medline、Embase和AMED中检索成本描述、成本比较、成本效益或成本效益研究报告。调查比较组的前瞻性研究被认为质量更高。
共纳入34份报告。初级保健中提供一系列疗法的回顾性研究表明，这些疗法可能会降低转诊和治疗成本，但前瞻性研究表明，补充医学是一项额外费用，不能替代传统治疗。对于个别疗法，一项全面但为回顾性的研究表明，针对性强的针灸可能会降低肌肉骨骼问题的转诊成本。一项关于脊柱推拿疗法的大型实用性研究表明，这种治疗可能会降低背痛的社会成本，但四项对照试验发现，推拿疗法并不能降低背痛患者自身或其医疗保险机构产生的成本。
脊柱推拿疗法治疗背痛可能为社会节省成本，但对购买者而言并不省钱。缺乏严格的研究能够提供确凿证据，证明其他补充疗法与传统医学在成本和疗效上存在差异。方法存在缺陷的研究证据与更严格的研究结果相矛盾，因此需要对补充医学的成本和效益进行高质量调查。
