Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Department of Psychosocial Oncology, Cancer Control Alberta, Holy Cross Centre Phase I, Calgary, Canada.
J Altern Complement Med. 2021 May;27(5):390-397. doi: 10.1089/acm.2020.0386. Epub 2021 Apr 27.
Individual acupuncture (AP) is the gold standard method of AP delivery for cancer-related pain; however, costs can be prohibitive. Group AP allows four to six patients to be treated in a single session. This study sought to examine the cost-utility of group AP compared with individual AP from a patient perspective. Effectiveness and cost data from a noninferiority randomized trial of group versus individual AP for cancer-related pain were used. In the trial, 74 patients were randomly assigned to individual or group AP treatments twice per week for 6 weeks. The EuroQol five-dimension five level questionnaire (EQ-5D-5L) was used to assess health-related quality of life, and the EQ-5D Utility Index was used as a composite measure constituted of five domains (mobility, self-care, usual activities, anxiety-depression, and pain-discomfort). Linear mixed models were used to compare the change in EQ-5D-5L states pre-post intervention between the two arms. A cost-utility analysis was performed in terms of the incremental costs per additional quality-adjusted life year (QALY) gained. Group AP participants experienced more significant relief in the pain-discomfort subscale of the EQ-5D-5L measure compared with individual AP participants ( × , = 6.18; = 0.02). The effect size on pain-discomfort for group AP ( = 0.80) was higher than that of individual AP ( = 0.34). There were no significant differences between the two study arms for other subscales of the EQ-5D-5L over time. QALYs at 6 weeks were slightly higher for group AP (0.020) compared with individual AP (0.007) leading to an incremental QALY gained by the group arm of 0.013, but this difference was not statistically significant ( = 0.07). The cost of delivering AP treatment for the group arm over 6 weeks ($201.25) was nearly half of the individual arm ($400). Group AP was superior to individual AP in cancer patients. These findings have implications for the use of group AP in low-resource settings and in health care systems where AP for cancer patients is not covered by public health insurance. ClinicalTrials.gov (NCT03641222). Registered July 10, 2018-Retrospectively registered, https://clinicaltrials.gov/ct2/show/study/NCT03641222.
个体针灸（AP）是治疗癌症相关疼痛的金标准方法；然而，成本可能过高。小组 AP 允许四名至六名患者在一次治疗中接受治疗。本研究旨在从患者角度探讨小组 AP 与个体 AP 的成本效用。使用了小组 AP 与个体 AP 治疗癌症相关疼痛的非劣效性随机试验的有效性和成本数据。在试验中，74 名患者被随机分配接受个体或小组 AP 治疗，每周两次，共 6 周。使用欧洲五维健康量表（EQ-5D-5L）评估健康相关生活质量，使用 EQ-5D 效用指数作为由五个域（移动性、自我护理、日常活动、焦虑-抑郁和疼痛不适）组成的综合测量。线性混合模型用于比较干预前后两组之间 EQ-5D-5L 状态的变化。根据获得的每增加一个质量调整生命年（QALY）的增量成本进行成本效用分析。与个体 AP 组相比，小组 AP 组在 EQ-5D-5L 测量的疼痛不适子量表中经历了更显著的缓解（ × ， = 6.18； = 0.02）。小组 AP 的疼痛不适效应量（ = 0.80）高于个体 AP（ = 0.34）。随着时间的推移，两组在 EQ-5D-5L 的其他子量表上没有显著差异。6 周时，小组 AP 的 QALY 略高（0.020），个体 AP （0.007），导致小组臂获得的增量 QALY 为 0.013，但这一差异无统计学意义（ = 0.07）。6 周小组 AP 治疗费用（201.25 美元）几乎是个体 AP（400 美元）的一半。小组 AP 在癌症患者中优于个体 AP。这些发现对小组 AP 在资源匮乏环境中的使用以及在癌症患者的 AP 不受公共医疗保险覆盖的医疗保健系统中具有重要意义。ClinicalTrials.gov（NCT03641222）。2018 年 7 月 10 日注册-回顾性注册，https://clinicaltrials.gov/ct2/show/study/NCT03641222。
