Witt C, Reinhold T, Jena S, Brinkhaus B, Liecker B, Willich SN.

Effectiveness and costs of acupuncture in patients with osteoarthritis—the acupuncture in routine care study (ARC).

Institute for Social Medicine, Epidemiology and Health Economics, University Medical Center Charité, Berlin 10098, Germany. Claudia.witt@charite.de

BACKGROUND: In a recent RCT in patients with osteoarthritis of the knee we observed significantly better results for the acupuncture group compared to a sham acupuncture group (Witt et. al. Lancet 2005). However, the effectiveness and cost-effectiveness of acupuncture in patients suffering from osteoarthritis of the hip or knee remains unclear.

OBJECTIVE: To evaluate the effectiveness and cost-effectiveness of acupuncture (in addition to routine medical care) in patients with osteoarthritis of the hip or knee.

METHODS: Patients ³40 years with chronic arthritis of the hip and the knee (symptom duration >6 months plus radiological alterations) were randomly allocated to: receive up to 15 acupuncture sessions over three months (ACU), or to a control group (CON) receiving no acupuncture. Study participants were allowed to receive additional usual medical care covered by statutory health insurance companies. By using standardised questionnaires we assessed socio-demographic data, symptoms of osteoarthritis (WOMAC) and health related quality of life (SF-36) at baseline, after 3 and 6 months. Data for direct costs and sick leave (number of days absent from work) were provided by the health insurance companies. The cost-effectiveness-analysis was performed from an overall cost perspective. Incremental cost-effectiveness-ratios (ICER) were calculated based on quality adjusted life years (QALYs) after 3 months.

RESULTS: A total of 632 patients were included (60.3% female, 60.5±10.4 years, 39.7% male, 62.2±10.3 years) and allocated to ACU (n=322) and CON (n=310). After 3 months treatment the WOMAC score improved more pronounced in the ACU compared to the CON group (WOMAC baseline to 3 months: ACU from 48.2±23.3 to 30.0±24.2, CON from 48.0±23.4 to 47.5±23.3, p<0.001). The improvement in the ACU group persisted up to 6 months. Furthermore, quality of life improved significantly more in the ACU group (p<0.001). ACU treatment was associated with higher overall costs compared to CON (p<0.001), mainly due to the acupuncture costs. There were more QALYs gained in the ACU compared to the CON (ACU-CON: 0.02±0.01). The incremental cost effectiveness ratio was 17,845 Euro/QALY gained.

CONCLUSION: Treatment with acupuncture of patients with osteoarthritis, in addition to routine care, was more effective than routine care without acupuncture and resulted in additional costs. However, according to international benchmarks it can be regarded as cost-effective. (Witt C, Brinkhaus B, Jena S, Linde K, Streng A, Wagenpfeil S, Hummelsberger J, Walther HU, Melchart D, Willich SN. Acupuncture in patients with osteoarthritis of the knee - a randomised trial [ART Osteoarthritis]. Lancet. 2005;366:136-143.)

 

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