4. Acupunctuur bij hoofdpijn

Effectief en kostenbesparend, 2 onderzoeken (Engels):

1. Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial

Objective: To determine the effects of a policy of "use acupuncture" on headache, health status, days off sick, and use of resources in patients with chronic headache compared with a policy of "avoid acupuncture."

Design: Randomised, controlled trial.

Setting: General practices in England and Wales.

Participants: 401 patients with chronic headache, predominantly migraine.

Interventions: Patients were randomly allocated to receive up to 12 acupuncture treatments over three months or to a control intervention offering usual care.

Main outcome measures: Headache score, SF-36 health status, and use of medication were assessed at baseline, three, and 12 months. Use of resources was assessed every three months.

Results: Headache score at 12 months, the primary end point, was lower in the acupuncture group (16.2, SD 13.7, n = 161, 34% reduction from baseline) than in controls (22.3, SD 17.0, n = 140, 16% reduction from baseline). The adjusted difference between means is 4.6 (95% confidence interval 2.2 to 7.0; P = 0.0002). This result is robust to sensitivity analysis incorporating imputation for missing data. Patients in the acupuncture group experienced the equivalent of 22 fewer days of headache per year (8 to 38). SF-36 data favoured acupuncture, although differences reached significance only for physical role functioning, energy, and change in health. Compared with controls, patients randomised to acupuncture used 15% less medication (P = 0.02), made 25% fewer visits to general practitioners (P = 0.10), and took 15% fewer days off sick (P = 0.2).

Conclusions: Acupuncture leads to persisting, clinically relevant benefits for primary care patients with chronic headache, particularly migraine. Expansion of NHS acupuncture services should be considered.

Bron: British Medical Journal 2004;328:744 (27 March), doi:10.1136/bmj.38029.421863.EB (published 15 March 2004) Andrew J Vickers , assistant attending research methodologist (1), Rebecca W Rees, research officer( )2, Catherine E Zollman, general practitioner (3), Rob McCarney, research officer (4), Claire M Smith, senior trials coordinator (5), Nadia Ellis, lecturer (6), Peter Fisher, director of research (7), Robbert Van Haselen, deputy director of research (7)

1: Integrative Medicine Service, Biostatistics Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, NY, NY 10021,

2: Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), Social Science Research Unit, Institute of Education, London WC1H 0NS,

3: Montpelier Health Centre, Bristol BS6 5PT,

4: Department of Psychological Medicine, Imperial College London, London W2 1PD,

5: Academic Rheumatology, Weston Education Centre, King's College, London SE5 9RJ,

6: Department of Health and Social Sciences, Coventry University, Coventry CV1 5FB,

7: Royal London Homeopathic Hospital, London W1W 5PB

2. Cost effectiveness analysis of a randomised trial of acupuncture for chronic headache in primary care

Objective: To evaluate the cost effectiveness of acupuncture in the management of chronic headache.

Design: Cost effectiveness analysis of a randomised controlled trial.

Setting: General practices in England and Wales.

Participants: 401 patients with chronic headache, predominantly migraine.

Interventions: Patients were randomly allocated to receive up to 12 acupuncture treatments over three months from appropriately trained physiotherapists, or to usual care alone.

Main outcome measure: Incremental cost per quality adjusted life year (QALY) gained.

Results: Total costs during the one year period of the study were on average higher for the acupuncture group (£403; $768; € 598) than for controls (£217) because of the acupuncture practitioners' costs. The mean health gain from acupuncture during the one year of the trial was 0.021 quality adjusted life years (QALYs), leading to a base case estimate of £9180 per QALY gained. This result was robust to sensitivity analysis. Cost per QALY dropped substantially when the analysis incorporated likely QALY differences for the years after the trial.

Conclusions: Acupuncture for chronic headache improves health related quality of life at a small additional cost; it is relatively cost effective compared with a number of other interventions provided by the NHS.

Bron: BritishMedical Journal 2004;328:747 (27 March), doi:10.1136/bmj.38033.896505.EB (published 15 March 2004)

David Wonderling , lecturer in health economics (1), Andrew J Vickers, assistant attending research methodologist (2), Richard Grieve, lecturer in health economics (1), Rob McCarney, research officer (3)

1: Health Services Research Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT,

2: Integrative Medicine Service, Biostatistics Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA,

3: Department of Psychological Medicine, Imperial College London, London W2 1PD

Laatst aangepast (zondag, 04 december 2011 21:47)