Background: Acupuncture is widely used by patients with neck pain, but there is a lack of information about its effectiveness and costs in routine medical care. The aim was to investigate the effectiveness and cost-effectiveness of acupuncture in addition to routine care in patients with chronic neck pain compared to treatment with routine care alone.

Methods: We performed a randomized controlled multicentre trial plus non-randomized cohort in general practices in Germany. Patients with chronic neck pain (duration >6 months) were randomly allocated to an acupuncture group or a control group receiving no acupuncture. Patients in the acupuncture group received up to 15 acupuncture sessions over three months. Patients who did not consent to randomization received acupuncture treatment. All subjects were allowed to receive usual medical care in addition to study treatment. Primary outcome was the Neck Pain and Disability (NPAD Scale by Wheeler) after three months. Furthermore, we assessed in both randomized arms the resource use and health related quality of life (SF-36) at baseline and after 3 months using complete social health insurance funds and standardized questionnaires, respectively. The main outcome parameters were direct and indirect cost differences during the 3 months study period and the incremental cost-effectiveness ratio (ICER) of acupuncture treatment.

Results: Of 14,161 patients (mean age 50.9+/-13.1 years, 68% female) 1880 were randomized to acupuncture and 1886 to control, and 10,395 included into the non-randomized acupuncture group. At three months, neck pain and disability improved by 16.2 (SE: 0.4) to 38.3 (SE: 0.4); and by 3.9 (SE: 0.4) to 50.5 (SE: 0.4), difference 12.3 (p<0.001) in the acupuncture and control group, respectively. Treatment success was essentially maintained through six months. Non-randomized patients had more severe symptoms at baseline and showed higher neck pain and disability improvement compared to randomized patients.
In the randomized groups (n= 1,753 acupuncture-group, 1,698 control-group) acupuncture treatment was associated with significantly higher costs over the 3 months study duration compared to routine care alone (925.53+/-1,551.06 euros vs. 648.06+/-1,459.13 euros; mean difference: 277.47 euros [95% CI: 175.71 euros-379.23 euros]). This cost increase was mainly due to costs of acupuncture (361.76+/-90.16 euros). The ICER was 12,469 euros per QALY gained and proved robust in additional sensitivity analyses.

Conclusion: Treatment with acupuncture added to routine care in patients with chronic neck pain was associated with improvements in neck pain and disability compared to treatment with routine care alone. According to international cost-effectiveness threshold values, acupuncture is a cost-effective treatment strategy in patients with chronic neck pain.

Publications:
Willich SN, Reinhold T, Selim D, Jena S, Brinkhaus B, Witt CM.Cost-effectiveness of acupuncture treatment in patients with chronic neck pain. Pain. 2006 Nov;125(1-2):107-13.

Witt CM, Jena S, Brinkhaus B, Liecker B, Wegscheider K, Willich SN.Acupuncture for patients with chronic neck pain. Pain. 2006 Nov;125(1-2):98-106.

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)