Economic evaluation of acupuncture as an adjunctive treatment with usual care for mild-to-moderate knee osteoarthritis: A Markov model-based analysis

IF 2.8 4区 医学 Q2 INTEGRATIVE & COMPLEMENTARY MEDICINE
Eunhye Hyun , Byung-Cheul Shin , NamKwen Kim , Byungmook Lim
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引用次数: 0

Abstract

Background

Collaborative care (CC), in which acupuncture is combined with usual care (UC), improves clinical outcomes and increases costs in knee osteoarthritis (KOA). We evaluated the economic feasibility of CC for Korean female patients with mild-to-moderate KOA by using a cost-effectiveness approach.

Methods

Two alternatives for KOA (1. UC as a comparator; and 2. CC as an intervention) were defined based on clinical guidelines, official Korean statistics, and expert validation. Each alternative was simulated in a Markov model every 6 months for 10 years. Estimates of costs, utilities, and transition probabilities were obtained from official statistics and previous studies. The effectiveness of CC was synthesized from randomized controlled trials. A base-case analysis of a limited societal perspective, univariate sensitivity analysis, and probability sensitivity analysis were performed. An annual discount rate of 4.5% and threshold of 20,000 United States dollar per Quality-adjusted life year (USD/QALY) were applied.

Results

Every incremental cost-effectiveness ratio (ICER) of CC calculated from the analyses was sub-threshold. In the base-case analysis, with a limited societal perspective, the ICER was 11,085 USD/QALY. The ICERs from the univariate sensitivity analyses were -2,577–16,748 USD/QALY. The average ICER in the probability sensitivity analysis was 12,412 USD/QALY. When the threshold surpassed 8,000 USD/QALY, the cost-effectiveness of CC exceeded 50%. The probability was 70.27% when the threshold was 20,000 USD/QALY.

Conclusions

CC for Korean female patients with mild-to-moderate KOA was generally cost-effective. Considering the limitations of the evidence, we propose a re-evaluation using further clinical studies in the future.

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针灸作为常规护理辅助治疗轻中度膝骨关节炎的经济评价:基于马尔可夫模型的分析
背景协同护理(CC),即针灸与常规护理(UC)相结合,可以改善膝骨关节炎(KOA)的临床疗效并增加成本。我们使用成本效益方法评估了CC治疗轻度至中度KOA的韩国女性患者的经济可行性。方法KOA的两种替代方案(1。UC作为比较器;和2。CC作为一种干预措施)的定义基于临床指南、韩国官方统计数据和专家验证。在马尔可夫模型中每6个月对每个备选方案进行10年的模拟。对成本、公用事业和过渡概率的估计是从官方统计数据和以前的研究中获得的。CC的有效性是从随机对照试验中综合得出的。进行了有限社会视角的基本案例分析、单变量敏感性分析和概率敏感性分析。采用4.5%的年折扣率和20000美元/质量调整寿命年(美元/QALY)的门槛。结果通过分析计算出的CC的每个增量成本效益比(ICER)均在阈值以下。在基本案例分析中,在有限的社会视角下,ICER为11085美元/年。单变量敏感性分析得出的ICER为-2577–16748美元/年。概率敏感性分析中的平均ICER为12412美元/QALY。当阈值超过8000美元/QALY时,CC的成本效益超过50%。当阈值为20000美元/QALY时,概率为70.27%。结论CC治疗轻度至中度KOA的韩国女性患者通常具有成本效益。考虑到证据的局限性,我们建议在未来使用进一步的临床研究进行重新评估。
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来源期刊
Integrative Medicine Research
Integrative Medicine Research Medicine-Complementary and Alternative Medicine
CiteScore
6.50
自引率
2.90%
发文量
65
审稿时长
12 weeks
期刊介绍: Integrative Medicine Research (IMR) is a quarterly, peer-reviewed journal focused on scientific research for integrative medicine including traditional medicine (emphasis on acupuncture and herbal medicine), complementary and alternative medicine, and systems medicine. The journal includes papers on basic research, clinical research, methodology, theory, computational analysis and modelling, topical reviews, medical history, education and policy based on physiology, pathology, diagnosis and the systems approach in the field of integrative medicine.
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