Health economic evaluation of acupuncture along meridians for treating migraine in China: results from a randomized controlled trial

Zhu-qing Deng, Hui Zheng, Ling Zhao, Si-yuan Zhou, Ying Li, Fan-rong Liang, Zhu-qing Deng, Hui Zheng, Ling Zhao, Si-yuan Zhou, Ying Li, Fan-rong Liang

Abstract

Background: To evaluate different types of acupuncture treatment for migraine in China from the perspective of health economics, particularly the comparison between treatment of specific acupoints in Shaoyang meridians and penetrating sham acupoints treatment.

Methods: Data were obtained from a multicenter, randomized controlled trial of acupuncture treatment in patients with migraine. Four-hundred eighty migraineurs were randomly assigned to 3 arms of treatment with genuine acupoints and 1 arm of penetrating sham acupoints. The primary outcome measurement was the cost-effectiveness ratio (C/E), expressed as cost per 1 day reduction of headache days from baseline to week 16. Cost-comparison analyses, differences in the migraine-specific quality of life questionnaire (MSQ), and the incremental cost-effectiveness ratio were taken as secondary outcome measurements. In addition, a sensitivity analysis was conducted.

Results: The total cost per patient was ¥1273.2 (95% CI 1171.3-1375.1) in the Shaoyang specific group, ¥1427.7 (95% CI 1311.8-1543.6) in the Shaoyang non-specific group, ¥1490.8 (95% CI 1327.1-1654.6) in the Yangming specific group, and ¥1470.1 (95% CI 1358.8-1581.3) in the sham acupuncture group. The reduced days with migraine were 3.972 ± 2.7, 3.555 ± 2.8, 3.793 ± 3.6, and 2.155 ± 3.7 in these 4 groups (P < 0.05 for each genuine acupoints group vs the sham group), respectively, at week 16. The C/Es of the 4 groups were 320.5, 401.6, 393.1, and 682.2, respectively. Results of the sensitivity analysis were consistent with that of the cost-effectiveness analysis. The Shaoyang specific group significantly improved in all 3 MSQ domains compared with the sham acupuncture group.

Conclusions: Treatment of specific acupoints in Shaoyang meridians is more cost-effective than that of non-acupoints, representing a dramatic improvement in the quality of life of people with migraine and a significant reduction in cost. Compared with the other 3 groups, Shaoyang-specific acupuncture is a relatively cost-effective treatment for migraine prophylaxis in China.

Trial registration: Clinical Trials.gov NCT00599586.

Figures

Figure 1
Figure 1
MSQ mean scores at various time points. * Shaoyang-specific group vs. sham acupuncture group, P < 0.05. † Shaoyang-non-specific group vs. sham acupuncture group, P < 0.05. ‡ Yangming-specific group vs. sham acupuncture group, P < 0.05.
Figure 2
Figure 2
Sensitivity analyses. The cost-effectiveness ratio varied by acupuncture fees, which were allowed to drift up and down by 10%-20%. C = Total cost (CNY).

References

    1. Headache Classification Subcommittee of the International Headache Society (IHS) The international classification of headache disorder, 2nd edn. Cephalalgia. 2004;24(suppl 1):9–160.
    1. Stovner LJ, Zwart JA, Hagen K. Epidemiology of headache in Europe. Eur J Neurol. 2006;13(4):333–345. doi: 10.1111/j.1468-1331.2006.01184.x.
    1. Lipton RB, Stewart WF, Diamond S. Prevalence and burden of migraine in the United States: data from the American Migraine Study II. Headache. 2001;41(7):646–657. doi: 10.1046/j.1526-4610.2001.041007646.x.
    1. Leonardi M, Mathers C. Global burden of migraine in the year 2000: summary of methods and data sources.Global Burden Disease 2000 Working Paper. WHO, Geneva; ]Accessed January 12, 2012.
    1. Hu XH, Markson LE. Burden of migraine in the United States: disability and economic costs. Arch Intern Med. 1999;159(8):813–818. doi: 10.1001/archinte.159.8.813.
    1. Witt CM, Reinhold T, Jena S. Cost-effectiveness of acupuncture treatment in patients with headache. Cephalalgia. 2008;28(4):334–345. doi: 10.1111/j.1468-2982.2007.01504.x.
    1. Wonderling D, Vickers AJ, Grieve R. Cost effectiveness analysis of a randomised trial of acupuncture for chronic headache in primary care. BMJ. 2004;328(7442):747–749. doi: 10.1136/bmj.38033.896505.EB.
    1. Li Y, Liang F, Yu S. et al.Randomized controlled trial to treat migraine with acupuncture: design and protocol. Trials. 2008;9(1):57. doi: 10.1186/1745-6215-9-57.
    1. Li Y, Zheng H, Witt CM. et al.Acupuncture for migraine prophylaxis: a randomized controlled trial. CMAJ. 2012;184(4):401–410. doi: 10.1503/cmaj.110551.
    1. Statistics Bureau of Wuhan Municipality. Wuhan statistical yearbook 2008. China Statistics Press, Beijing; 2008.
    1. Statistics Bureau of Ningxia Province. Ningxia statistical yearbook 2008. China Statistics Press, Beijing; 2008.
    1. Statistics Bureau of Sichuan Province. Sichuan statistical yearbook 2008. China Statistics Press, Beijing; 2008.
    1. Statistics Bureau of Hunan Province. Hunan statistical yearbook 2008. China Statistics Press, Beijing; 2008.
    1. Linde K, Allais G, Brinkhaus B. Acupuncture for migraine prophylaxis. Cochrane Database Syst Rev. 2009;21(1):CD001218.
    1. Cole JC, Lin P, Rupnow MF. Validation of the Migraine-Specific Quality of Life Questionnaire version 2.1 (MSQ v. 2.1) for patients undergoing prophylactic migraine treatment. Qual Life Res. 2007;16(7):1231–1237. doi: 10.1007/s11136-007-9217-1.
    1. Dahlöf C, Loder E, Diamond M. The impact of migraine prevention on daily activities: a longitudinal and responder analysis from three topiramate placebo-controlled clinical trials. Health Qual Life Outcomes. 2007;5:56. doi: 10.1186/1477-7525-5-56.
    1. Martin BC, Pathak DS, Sharfman MI. Validity and reliability of the migraine-specific quality of life questionnaire (MSQ Version 2.1) Headache. 2000;40(3):204–215. doi: 10.1046/j.1526-4610.2000.00030.x.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa