Complementary therapy costly and of limited benefit
Complementary treatments represent an additional cost to usual care in the UK and have questionable clinical benefit, a review in the BMJ argues (2005;331:880).
The review comes a week after economist Christopher Smallwood’s
report “The
role of complementary and alternative medicine in the NHS” was published, recommending that the National Institute for
Health and Clinical Excellence carry out a full assessment of the cost-effectiveness
of complementary therapies. The report also argues that the potential
role of complementary therapies within the NHS should be assessed, particularly
in relation to closing “effectiveness gaps” around chronic
musculoskeletal and psychosocial conditions which, the report argues,
often cannot be successfully tackled by conventional treatment.
Mr Smallwood concludes that there is sufficient evidence to suggest that
some complementary therapies may be more effective than conventional
approaches in these areas. And, he argues, even if some complementary
therapies are more expensive than traditional therapy, they may nonetheless
be found to be cost effective by reducing treatment times, and so the
time patients take off work, leading to wider economic benefits. The
report was commissioned by the Prince of Wales.
The BMJ review examines all prospective controlled studies looking at
the cost-effectiveness of complementary medicine that were conducted
in the UK before April. Five studies fitted these criteria — one
of acupuncture for chronic headache and four of manipulation for spinal
pain. Acupuncture
was an effective addition to usual care for chronic headache, but cost
an additional £9,180 per quality adjusted life year (QALY). Subacute
spinal pain and chronic back pain spinal manipulation each cost £3,560
and £4,800 more, respectively, per QALY than usual care. These
estimates of cost per QALY compare favourably with other treatments approved
for use in the NHS, the authors say but, for spinal manipulation, the
health benefits were small and of questionable clinical significance
and, in all the studies, measurement of costs omitted follow-on costs.
The trials may also have over-estimated the effectiveness of the treatments
and so over-estimated their cost effectiveness, the authors add. “Absence
of blinding and sham control treatments may have increased
non-specific treatment effects. Estimates of cost effectiveness may be
less favourable in situations for which the complementary treatment is
offered routinely rather than in the novel situation of a clinical trial,” they
conclude. |
The
Pharmaceutical Journal
Acrobat
Reader