PT  - JOURNAL ARTICLE
AU  - Whitehurst, David G.T.
AU  - Bryan, Stirling
AU  - Hay, Elaine M.
AU  - Thomas, Elaine
AU  - Young, Julie
AU  - Foster, Nadine E.
TI  - Cost-Effectiveness of Acupuncture Care as an Adjunct to Exercise-Based Physical Therapy for Osteoarthritis of the Knee
AID  - 10.demo/ptj.20100239
DP  - 2011 May 01
TA  - Demo Journal of Physical Therapy
PG  - 630--641
VI  - 91
IP  - 5
4099  - http://demo.highwire.org/content/91/5/630.short
4100  - http://demo.highwire.org/content/91/5/630.full
AB  - Background The delivery of acupuncture alongside mainstream interventions and the cost-effectiveness of “alternative” treatments remain areas of controversy.Objective The aim of this study was to assess the cost-utility of adding acupuncture to a course of advice and exercise delivered by UK National Health Service (NHS) physical therapists to people with osteoarthritis of the knee.Design A cost-utility analysis was performed alongside a randomized controlled trial.Methods A total of 352 adults (aged 50 years or older) were randomly assigned to receive 1 of 3 interventions. The primary analysis focused on participants receiving advice and exercise (AE) or advice and exercise plus true acupuncture (AE+TA). A secondary analysis considered participants receiving advice and exercise plus nonpenetrating acupuncture (AE+NPA). The main outcome measures were quality-adjusted life years (QALYs), measured by the EQ-5D, and UK NHS costs. Results were expressed as the incremental cost per QALY gained over 12 months. Sensitivity analyses included a broader cost perspective to incorporate private out-of-pocket costs.Results NHS costs were higher for AE+TA (£314 [British pounds sterling]) than for AE alone (£229), and the difference in mean QALYs favored AE+TA (mean difference=0.022). The base-case cost per QALY gained was £3,889; this value was associated with a 77% probability that AE+TA would be more cost-effective than AE at a threshold of £20,000 per QALY. Cost-utility data for AE+NPA provided cost-effectiveness estimates similar to those for AE+TA.Limitations As with all trial-based economic evaluations, caution should be exercised when generalizing results beyond the study perspectives.Conclusions A package of AE+TA delivered by NHS physical therapists provided a cost-effective use of health care resources despite an associated increase in costs. However, the economic benefits could not be attributed to the penetrating nature of conventional acupuncture; therefore, further research regarding the mechanisms of acupuncture is needed. An analysis of alternative cost perspectives suggested that the results are generalizable to other health care settings.