Wonderling David, Vickers Andrew J, Grieve Richard, McCarney Rob
Health Services Research Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT.
BMJ. 2004 Mar 27;328(7442):747. doi: 10.1136/bmj.38033.896505.EB. Epub 2004 Mar 15.
To evaluate the cost effectiveness of acupuncture in the management of chronic headache.
Cost effectiveness analysis of a randomised controlled trial.
General practices in England and Wales.
401 patients with chronic headache, predominantly migraine. Interventions Patients were randomly allocated to receive up to 12 acupuncture treatments over three months from appropriately trained physiotherapists, or to usual care alone.
Incremental cost per quality adjusted life year (QALY) gained.
Total costs during the one year period of the study were on average higher for the acupuncture group (403 pounds sterling; 768 dollars; 598 euros) than for controls (217 pounds sterling) because of the acupuncture practitioners' costs. The mean health gain from acupuncture during the one year of the trial was 0.021 quality adjusted life years (QALYs), leading to a base case estimate of 9180 pounds sterling per QALY gained. This result was robust to sensitivity analysis. Cost per QALY dropped substantially when the analysis incorporated likely QALY differences for the years after the trial.
Acupuncture for chronic headache improves health related quality of life at a small additional cost; it is relatively cost effective compared with a number of other interventions provided by the NHS.
评估针刺疗法治疗慢性头痛的成本效益。
一项随机对照试验的成本效益分析。
英格兰和威尔士的全科医疗诊所。
401例慢性头痛患者，主要为偏头痛患者。干预措施：患者被随机分配，接受由经过适当培训的物理治疗师在三个月内进行的多达12次针刺治疗，或仅接受常规护理。
每获得一个质量调整生命年（QALY）的增量成本。
由于针刺治疗师的费用，在研究的一年期间，针刺组的总成本平均高于对照组（针刺组为403英镑；768美元；598欧元，对照组为217英镑）。在试验的一年中，针刺疗法带来的平均健康改善为0.021个质量调整生命年（QALYs），得出每获得一个QALY的基础病例估计成本为9180英镑。该结果在敏感性分析中具有稳健性。当分析纳入试验后几年可能的QALY差异时，每QALY的成本大幅下降。
针刺治疗慢性头痛以少量额外成本改善了与健康相关的生活质量；与英国国家医疗服务体系（NHS）提供的其他一些干预措施相比，它具有相对成本效益。
