Cost-Effectiveness of Acupuncture Care as an Adjunct to Exercise-Based Physical Therapy for Osteoarthritis of the Knee

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 non-penetrating 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 pound [British pounds sterling]) than for AE alone (229) pound, and the difference in mean QALYs favored AE+TA (mean difference=0.022). The base-case cost per QALY gained was 3,889; pound this value was associated with a 77% probability that AE+TA would be more cost-effective than AE at a threshold of 20,000 pound 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.