Department of Neurology, The Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China.
South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China.
Front Public Health. 2021 Aug 16;9:689753. doi: 10.3389/fpubh.2021.689753. eCollection 2021.
From the health care and societal perspectives, this study aimed to evaluate the clinical and economic effects of acupuncture as an adjunctive therapy for patients receiving methadone maintenance treatment (MMT). We conducted a parallel-arm RCT in China in 2019. Patients were included who met the diagnostic criteria and receive MMT for more than 30 days. Patients were randomly assigned to the exposed group (acupuncture plus MMT) or control group (MMT) at a 1:1 ratio. Daily methadone dosage, drug cravings using the VAS score, and insomnia using the Pittsburgh Sleep Quality Index (PSQI) were chosen as the effectiveness indexes, and the quality-adjusted life years (QALYs) was chosen as the utility index. Overall, 123 patients were included. The exposed group was significantly ( < 0.05) better than the control group in the improvement of daily methadone dosage (17.68 vs. 1.07), VAS (38.27 vs. 2.64), and PSQI (2.18 vs. 0.30). The QALY was 0.0784 (95%CI: 0.0761-0.0808) for the exposed group and 0.0762 (95%CI: 0.0738-0.0787) for the control group. The total cost of the exposed group (2869.50 CNY) was higher than the control group (2186.04 CNY). The ICER of daily methadone dosage (41.15), VAS (17.86), and PSQI (313.51) were shown to be economically efficient. While ICUR (310,663.64 CNY/QYLY) was higher than the cost suggested by WHO. Acupuncture as an adjuvant therapy for MMT patients realizes its cost-effectiveness by reducing the dosage of methadone, improving drug cravings, and alleviating insomnia. It helps to improve quality of life, but since its cost exceeds what society is willing to pay, further study is needed.
从医疗保健和社会角度来看，本研究旨在评估针灸作为辅助治疗接受美沙酮维持治疗（MMT）患者的临床和经济效果。我们于 2019 年在中国进行了一项平行臂 RCT。纳入符合诊断标准并接受 MMT 治疗超过 30 天的患者。将患者以 1:1 的比例随机分配到暴露组（针灸加 MMT）或对照组（MMT）。每日美沙酮剂量、视觉模拟量表（VAS）评分的药物渴求以及匹兹堡睡眠质量指数（PSQI）的失眠被选为有效性指标，而质量调整生命年（QALYs）被选为效用指标。共有 123 名患者入选。暴露组在改善每日美沙酮剂量（17.68 对 1.07）、VAS（38.27 对 2.64）和 PSQI（2.18 对 0.30）方面明显优于对照组（<0.05）。暴露组的 QALY 为 0.0784（95%CI：0.0761-0.0808），对照组为 0.0762（95%CI：0.0738-0.0787）。暴露组（2869.50 元）的总费用高于对照组（2186.04 元）。每日美沙酮剂量（41.15）、VAS（17.86）和 PSQI（313.51）的 ICER 显示出经济效率。而 ICUR（310,663.64 元/QALY）高于世界卫生组织建议的成本。针灸作为 MMT 患者的辅助治疗，通过减少美沙酮剂量、改善药物渴求、缓解失眠来实现其成本效益。它有助于提高生活质量，但由于其成本超过社会愿意支付的成本，因此需要进一步研究。
