Dagmar Selim

Cost-effectiveness of acupuncture treatment in patients with chronic neck pain

&NA; Acupuncture is increasingly used in patients with chronic pain, but there is a lack of evidence on the cost–benefit relationship of this treatment strategy. The objective of this study was to assess costs and cost‐effectiveness of additional acupuncture treatment in patients with chronic neck pain compared to patients receiving routine care alone. A randomized controlled trial including patients (≥18 years of age) with chronic neck pain (>6 months) was carried out. We assessed 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. A total of 3,451 patients (1,753 acupuncture‐group, 1,698 control‐group) were randomized (31% men, age 53.5 ± 12.9 years; 69% women, 49.2 ± 12.7 years). Acupuncture treatment was associated with significantly higher costs over the 3 months study duration compared to routine care (&U20AC;925.53 ± 1,551.06 vs. &U20AC;648.06 ± 1,459.13; mean difference: &U20AC;277.47 [95% CI: &U20AC;175.71–&U20AC;379.23]). This cost increase was mainly due to costs of acupuncture (&U20AC;361.76 ± 90.16). The ICER was &U20AC;12,469 per QALY gained and proved robust in additional sensitivity analyses. Since health insurance databases were used, private medical expenses such as over the counter medication were not included. Beyond the 3 months study duration, acupuncture might be associated with further health economic effects. According to international cost‐effectiveness threshold values, acupuncture is a cost‐effective treatment strategy in patients with chronic neck pain.

Economic assessment of adjustable maintenance treatment with budesonide/formoterol in a single inhaler versus fixed treatment in asthma.

AbstractObjectives: To compare the costs and effectiveness of adjustable maintenance dosing with budesonide/formoterol in a single inhaler versus fixed dosing in adults with asthma. Methods: In this prospective, randomised, open-label, parallel-group, multicentre trial conducted in Germany, patients with asthma received budesonide/formoterol 160µg/4.5µg in a single inhaler (Symbicort® Turbuhaler®) with two inhalations twice daily for a 4-week run-in period. Patients were then randomised to either adjustable maintenance dosing (one inhalation twice daily, stepping up to four inhalations twice daily for 1 week if asthma worsened; n = 1679) or fixed dosing (two inhalations twice daily; n = 1618) for 12 weeks. The primary efficacy variable was the change in health-related quality of life (HR-QOL), measured using the Asthma Quality of Life Questionnaire (standardised) during the randomised treatment period. Resource utilisation data were collected in parallel and combined with German unit costs to estimate direct and indirect costs (year 2001 values). Results: Both treatment regimens were equally effective in maintaining HR-QOL and asthma control during the randomised treatment period. However, overall, patients in the adjustable maintenance dosing group took fewer daily inhalations of budesonide/formoterol than those in the fixed-dosing group (mean: 2.63 vs 3.82 inhalations; p < 0.001). Adjustable maintenance dosing was associated with significantly lower asthma-related direct costs compared with fixed dosing (mean: €221 vs €292; p < 0.001). This pattern was maintained when patients were stratified into those with peak expiratory flow (PEF) of 60% to <80% predicted normal and those with PEF of ≥80% predicted normal and when total costs were considered. Conclusion: Adjustable maintenance dosing with budesonide/formoterol in a single inhaler maintained HR-QOL in adult patients with asthma at a significantly lower cost than fixed dosing.