Cost-Effectiveness of Acupuncture Needling for Older Adults With Chronic Low Back Pain

Abstract

Study design: Preplanned economic evaluation alongside a clinical trial.

Objective: Determine the 1-year cost-effectiveness from health care sector and Medicare perspectives of adding either standard acupuncture (SA; ≤15 treatment sessions over 12 wk) or enhanced acupuncture (EA; SA plus ≤ 6 additional sessions) to usual medical care (UMC) versus UMC alone.

Summary of background data: Chronic low back pain (CLBP) is common and expensive to treat largely due to the use of non-guideline-concordant pharmaceuticals and procedures. CLBP is also more common in older populations. Acupuncture has been shown to be effective and cost-effective for CLBP, but no studies have focused specifically on older adults.

Methods: Cost-utility and cost-effectiveness analyses comparing SA and EA to UMC using data from a randomized trial across three US health care systems. Bias-corrected and accelerated bootstrap techniques were used to generate 95% CIs.

Results: EA (n=225) reduced annual back pain-related health care sector costs by $491 (CI: -$2861, $1144) per participant versus UMC (n=225), and reduced Medicare-reimbursed costs by $421 (CI: -$2707, $1249) per participant. These cost savings came with a statistically and clinically significant gain in quality-adjusted life-years (QALYs; 0.037; CI: 0.013, 0.062), and a significant increase in the percentage of participants achieving a clinically meaningful improvement (CMI) in their Roland-Morris Disability Questionnaire scores (18.5% points; CI: 9.0%, 27.9%). SA (n=222) was more expensive than UMC; the incremental cost-effectiveness ratio from the health care sector perspective was $52,897/QALY. The QALY gains (0.014; CI: -0.014, 0.043) and increase in percentage of participants with a CMI (6.9%; CI: -2.7%, 16.4%) in SA versus UMC were not statistically significant.

Conclusion: EA was cost-saving and SA may be cost-effective from the health care sector and Medicare perspectives compared with UMC for older adults with CLBP in three large health care systems in California and Washington State.

Level of evidence: Level II.

Keywords: acupuncture; chronic low back pain; cost savings; cost-effectiveness analysis; cost-utility analysis; economic evaluation; health care utilization; maintenance care; medicare; older adults.