University of Sheffield, Health Economics and Decision Science, School of Health and Related Research, UK
Acupunct Med. 2012 Sep;30(3):182-6. doi: 10.1136/acupmed-2012-010152. Epub 2012 Jul 3.
Acupuncture received a positive recommendation in the National Institute for Health and Clinical Excellence (NICE) clinical guideline for low back pain (LBP). However, no such recommendation was forthcoming in the NICE clinical guideline for osteoarthritis (OA). Importantly, the two guidelines adopted different treatment comparators in their economic analyses of acupuncture; in the LBP guideline 'usual care' was used (with no consideration of placebo/sham interventions), whereas 'sham acupuncture' was the comparator in the OA guideline.
To analyse the implications of using different control group comparators when estimating the cost-effectiveness of acupuncture therapy.
The NICE OA economic analysis for acupuncture was replicated using 'usual care' (ie, no placebo/sham component) as the treatment comparator. A 'transfer-to-utility' technique was used to transform Western Ontario and McMaster Osteoarthritis scores into EQ-5D utility scores to allow quality-adjusted life year (QALY) gains to be estimated. QALY estimates were combined with direct incremental cost estimates of acupuncture treatment to determine incremental cost-effectiveness ratios (ICERs).
When 'usual care' was used as the treatment comparator, ICER point estimates were below £20 000 per QALY gained for each acupuncture trial analysed in the OA clinical guideline. In the original analysis, using placebo/sham acupuncture as the treatment comparator, ICERs were generally above £20 000 per QALY gained.
The treatment comparator chosen in economic evaluations of acupuncture therapy is likely to be a strong determinant of the cost-effectiveness results. Different comparators used in the OA and LBP NICE guidelines may have led to the divergent recommendations in the guidelines.
针刺在英国国家卫生与临床优化研究所（NICE）的腰痛（LBP）临床指南中得到了积极推荐。然而，在 NICE 的骨关节炎（OA）临床指南中并没有推荐针刺。重要的是，这两个指南在针刺的经济分析中采用了不同的治疗对照物；在 LBP 指南中，使用了“常规护理”（没有考虑安慰剂/假干预），而在 OA 指南中，“假针刺”是对照物。
分析在估计针刺治疗的成本效益时使用不同的对照组对照物的影响。
使用“常规护理”（即没有安慰剂/假成分）作为治疗对照物，复制 NICE 的 OA 经济分析。使用“转移到效用”技术将 Western Ontario 和 McMaster 骨关节炎评分转化为 EQ-5D 效用评分，以估计质量调整生命年（QALY）的增益。将 QALY 估计值与针刺治疗的直接增量成本估计值相结合，以确定增量成本效益比（ICER）。
当使用“常规护理”作为治疗对照物时，对于 OA 临床指南中分析的每个针刺试验，ICER 点估计值都低于每获得一个 QALY 20000 英镑。在原始分析中，使用安慰剂/假针刺作为治疗对照物，ICER 通常高于每获得一个 QALY 20000 英镑。
针刺治疗的经济评估中选择的治疗对照物很可能是成本效益结果的重要决定因素。NICE 指南中 OA 和 LBP 使用的不同对照物可能导致指南中的建议存在分歧。
