Institute for Social Medicine , Epidemiology and Health Economics, Charité-University Medical Center, Berlin, Germany .
J Altern Complement Med. 2014 Mar;20(3):169-77. doi: 10.1089/acm.2012.0719. Epub 2013 Nov 20.
Acupuncture is increasingly used in patients with allergic asthma, but there is a lack of evidence on the cost-benefit relationship of this treatment. The aim of this study was to assess economic aspects of additional acupuncture treatment in patients with allergic bronchial asthma compared to patients receiving routine care alone. DESIGN, SUBJECTS, INTERVENTION, OUTCOME MEASURES: In a randomized controlled trial, patients with allergic bronchial asthma were either allocated to a group receiving acupuncture immediately or a waiting-list control group. Both groups were free to use routine care treatment. The resource consumption, costs, and health-related quality of life were evaluated at baseline, and after 3 and 6 months by using statutory health insurance information and standardized questionnaires. Main economic outcome parameters were direct and indirect cost differences during the study period and the incremental cost-effectiveness ratio (ICER) of acupuncture treatment.
Three hundred and six (306) patients (159 acupuncture; 147 controls) were included (mean age 46.5±13.11 years, female 57.2%) and were comparable at baseline. Acupuncture treatment was associated with significantly higher costs compared to control patients (overall costs: €860.76 [95% confidence interval (CI) 705.04-1016.47] versus €518.80 [95% CI 356.66-680.93]; p=0.003; asthma-related costs: €517.52 [95% CI 485.63-549.40] versus €144.87 [95% CI 111.70-178.05]; p<0.001). These additional costs seem essentially driven by acupuncture costs themselves (€378.40 [95% CI 367.10-389.69]). However, acupuncture was associated with superior effectiveness in terms of quality-adjusted life years (QALYs). Resulting ICER lay between €23,231 (overall) and €25,315 (diagnosis-specific) per additional QALY. When using German acupuncture prices of year 2012, the ICER would improve to €12.810 (overall) versus €14,911 (diagnosis-specific) per QALY gained.
Treating patients who have allergic bronchial asthma with acupuncture in addition to routine care resulted in additional costs and better effects in terms of patients' quality of life. Acupuncture therefore seems to be a useful and cost-effective add-on treatment.
针灸在过敏性哮喘患者中的应用日益增多，但关于这种治疗方法的成本效益关系尚缺乏证据。本研究旨在评估过敏性支气管哮喘患者接受针灸治疗与仅接受常规护理相比的经济学方面。
设计、对象、干预、结局指标：在一项随机对照试验中，将过敏性支气管哮喘患者分为接受针灸治疗的即刻组或等待名单对照组。两组均可自由使用常规护理治疗。在基线、3 个月和 6 个月时，使用法定健康保险信息和标准化问卷评估资源消耗、成本和健康相关生活质量。主要的经济结局参数是研究期间的直接和间接成本差异以及针灸治疗的增量成本效益比（ICER）。
共纳入 306 例患者（159 例接受针灸治疗，147 例接受对照组）（平均年龄 46.5±13.11 岁，女性 57.2%），基线时两组具有可比性。与对照组患者相比，针灸治疗的费用明显更高（总费用：€860.76 [95%置信区间（CI）705.04-1016.47] 比 €518.80 [95% CI 356.66-680.93]；p=0.003；哮喘相关费用：€517.52 [95% CI 485.63-549.40] 比 €144.87 [95% CI 111.70-178.05]；p<0.001）。这些额外的成本主要由针灸治疗本身（€378.40 [95% CI 367.10-389.69]）驱动。然而，针灸在质量调整生命年（QALY）方面与更高的疗效相关。结果表明，每增加一个 QALY 的增量成本效益比（ICER）为€23,231（总体）至€25,315（诊断特异性）。当使用 2012 年德国针灸价格时，ICER 将改善为€12.810（总体）与€14,911（诊断特异性）每增加一个 QALY。
在常规护理的基础上，对过敏性支气管哮喘患者进行针灸治疗会增加成本，但在提高患者生活质量方面具有更好的效果。因此，针灸似乎是一种有用且具有成本效益的附加治疗方法。
