Objective: To investigate the effectiveness and cost-effectiveness of acupuncture in addition to routine care, compared with routine care alone, in the treatment of patients with chronic pain due to osteoarthritis (OA) of the knee or hip.

Methods: In a randomized, controlled trial, patients with chronic pain due to OA of the knee or hip were randomly allocated to undergo up to 15 sessions of acupuncture in a 3-month period or to a control group receiving no acupuncture. Another group of patients who did not consent to randomization underwent acupuncture treatment. All patients were allowed to receive usual medical care in addition to the study treatment. Clinical OA severity (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]) and health-related quality of life (Short Form 36) were assessed at baseline and after 3 months and 6 months. Randomized patients were included into the cost and cost-effectiveness analyses using health insurance funds data and standardized questionnaires.

Results: Of 3,633 patients (mean +/- SD age 61.8 +/- 10.8 years; 61% female), 357 were randomized to the acupuncture group and 355 to the control group, and 2,921 were included in the nonrandomized acupuncture group. 489 could be included into the cost-effectiveness analyses. At 3 months, the WOMAC had improved by a mean +/- SEM of 17.6 +/- 1.0 in the acupuncture group and 0.9 +/- 1.0 in the control group (3-month scores 30.5 +/- 1.0 and 47.3 +/- 1.0, respectively [difference in improvement 16.7 +/- 1.4; P < 0.001]). Similarly, quality of life improvements were more pronounced in the acupuncture group versus the control group (P < 0.001). Treatment success was maintained through 6 months. The changes in outcome in nonrandomized patients were comparable with those in randomized patients who received acupuncture. Patients receiving acupuncture in the randomized group had an improved QoL associated with significantly higher costs over the 3 months treatment period compared to the routine care alone control group (mean cost-difference: 469.50 euros [95%CI 135.80-803.19 euros]). This increase in costs was primarily due to the costs of acupuncture. The overall ICER was 17,845 euros per QALY gained. The degree of cost-effectiveness was influenced by gender, with female patients achieving a better cost-effectiveness ratio than men.

Conclusion: These results indicate that acupuncture plus routine care is associated with marked clinical improvement in patients with chronic OA-associated pain of the knee or hip. Acupuncture was a cost-effective treatment strategy in patients with chronic osteoarthritis pain strategy in patients with chronic osteoarthritis pain.

Publication:

Witt CM, Jena S, Brinkhaus B, Liecker B, Wegscheider K, Willich SN. Acupuncture in patients with osteoarthritis of the knee or hip. Arthritis & Rheumatism 2006;54(11):3485-3493.Reinhold T, Witt CM, Jena S, Brinkhaus B, Willich SN. Quality of life and cost-effectiveness of acupuncture treatment in patients with osteoarthritis pain. Eur J Health Econ 2008;9(3):209-219.

Principle investigator:
Willich, MD, MPH, MBA
Witt, MD, MBA

Research associate:
Jena, PhD
Brinkhaus, MD
Reinhold, PhD

Statistics:
Wegscheider, PhD

Data management:
Icke

Study nurse:
Eden
Bartsch

Project duration:
2000-2007

Project status:
completed

Funding:
Techniker Krankenkasse (statutory health insurance)