Cost-effectiveness of acupuncture versus standard care for pelvic and low back pain in pregnancy: A randomized controlled trial

Stephanie Nicolian, Thibault Butel, Laetitia Gambotti, Manon Durand, Antoine Filipovic-Pierucci, Alain Mallet, Mamadou Kone, Isabelle Durand-Zaleski, Marc Dommergues, Stephanie Nicolian, Thibault Butel, Laetitia Gambotti, Manon Durand, Antoine Filipovic-Pierucci, Alain Mallet, Mamadou Kone, Isabelle Durand-Zaleski, Marc Dommergues

Abstract

Objective: To assess the cost-effectiveness of acupuncture for pelvic girdle and low back pain (PGLBP) during pregnancy.

Design: Pragmatic-open-label randomised controlled trial.

Setting: Five maternity hospitals.

Population: Pregnant women with PGLBP.

Method: 1:1 randomization to standard care or standard care plus acupuncture (5 sessions by an acupuncturist midwife).

Main outcome measure: Efficacy: proportion of days with self-assessed pain by numerical rating scale (NRS) ≤ 4/10. Cost effectiveness (societal viewpoint, time horizon: pregnancy): incremental cost per days with NRS ≤ 4/10. Indirect non-healthcare costs included daily compensations for sick leave and productivity loss caused by absenteeism or presenteeism.

Results: 96 women were allocated to acupuncture and 103 to standard care (total 199). The proportion of days with NRS ≤ 4/10 was greater in the acupuncture group than in the standard care group (61% vs 48%, p = 0.007). The mean Oswestry disability score was lower in the acupuncture group than with standard care alone (33 versus 38, Δ = 5, 95% CI: 0.8 to 9, p = 0.02). Average total costs were higher in the control group (€2947) than in the acupuncture group (€2635, Δ = -€312, 95% CI: -966 to +325), resulting from the higher indirect costs of absenteeism and presenteeism. Acupuncture was a dominant strategy when both healthcare and non-healthcare costs were included. Costs for the health system (employer and out-of-pocket costs excluded) were slightly higher for acupuncture (€1512 versus €1452, Δ = €60, 95% CI: -272 to +470).

Conclusion: Acupuncture was a dominant strategy when accounting for employer costs. A 100% probability of cost-effectiveness was obtained for a willingness to pay of €100 per days with pain NRS ≤ 4.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Flow chart.
Fig 1. Flow chart.
Fig 2. Cost effectiveness plane, outcome: number…
Fig 2. Cost effectiveness plane, outcome: number of days with pain numerical rating scale ≤ 4/10, costs from the societal perspective.
We performed 2,000 bootstrap replications of the cost effectiveness ratio. The outcome was the number of days with pain NRS ≤ 4/10 between inclusion and delivery, expressed as a difference between acupuncture and standard care. All costs were taken into account. Acupuncture was always more effective and had a 70% probability of being less costly than routine care. Results for reduction on pain scales and weeks with disability were similar (S3 Fig). Fig 3 shows the probability of the intervention being cost effective using the base case data for a range of cost effectiveness ceilings. There was a nearly 100% probability that the cost per day of pain averted was below €100.
Fig 3. Acceptability curve (price for 1…
Fig 3. Acceptability curve (price for 1 day with pain NRS ≤ 4/10) from the societal perspective.
Fig 3 shows the probability of the intervention being cost effective using the base case data for a range of cost effectiveness ceilings. Hospital: hospital costs only, Insurance: health insurance costs added, patient: costs at the patient’s charge added, society: costs related to absenteeism and presenteeism added.

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