Economic evaluation of acupuncture as an adjunctive treatment with usual care for mild-to-moderate knee osteoarthritis: A Markov model-based analysis
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 appr...
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Elsevier
2023-09-01
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| Series: | Integrative Medicine Research |
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| author | Eunhye Hyun Byung-Cheul Shin NamKwen Kim Byungmook Lim |
| author_facet | Eunhye Hyun Byung-Cheul Shin NamKwen Kim Byungmook Lim |
| author_sort | Eunhye Hyun |
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| description | 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. |
| format | Article |
| id | doaj-art-c2bd60b05ad645cb9ea82e2bf1d7f37a |
| institution | DOAJ |
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| language | English |
| publishDate | 2023-09-01 |
| publisher | Elsevier |
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| series | Integrative Medicine Research |
| spelling | doaj-art-c2bd60b05ad645cb9ea82e2bf1d7f37a2025-08-20T03:04:50ZengElsevierIntegrative Medicine Research2213-42202023-09-0112310098210.1016/j.imr.2023.100982Economic evaluation of acupuncture as an adjunctive treatment with usual care for mild-to-moderate knee osteoarthritis: A Markov model-based analysisEunhye Hyun0Byung-Cheul Shin1NamKwen Kim2Byungmook Lim3Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Republic of KoreaDepartment of Korean Medicine Rehabilitation, Korean Medicine Hospital, Pusan National University, Yangsan, Republic of KoreaCenter for Big data & Comparative Effectiveness Research Economic Evaluation in Health and Medicine, Pusan National University, Yangsan, Republic of KoreaDivision of Humanities and Social Medicine, School of Korean Medicine, Pusan National University, Yangsan, Republic of Korea; Corresponding author at: Division of Humanities and Social Medicine, School of Korean Medicine, Pusan National University, Busandaehak-ro 49, Mulgeum-eup, Yangsan, 50612 Republic of Korea.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.http://www.sciencedirect.com/science/article/pii/S2213422023000616AcupunctureEconomic evaluationKnee osteoarthritisKorean medicineMarkov model |
| spellingShingle | Eunhye Hyun Byung-Cheul Shin NamKwen Kim Byungmook Lim Economic evaluation of acupuncture as an adjunctive treatment with usual care for mild-to-moderate knee osteoarthritis: A Markov model-based analysis Integrative Medicine Research Acupuncture Economic evaluation Knee osteoarthritis Korean medicine Markov model |
| title | Economic evaluation of acupuncture as an adjunctive treatment with usual care for mild-to-moderate knee osteoarthritis: A Markov model-based analysis |
| title_full | Economic evaluation of acupuncture as an adjunctive treatment with usual care for mild-to-moderate knee osteoarthritis: A Markov model-based analysis |
| title_fullStr | Economic evaluation of acupuncture as an adjunctive treatment with usual care for mild-to-moderate knee osteoarthritis: A Markov model-based analysis |
| title_full_unstemmed | Economic evaluation of acupuncture as an adjunctive treatment with usual care for mild-to-moderate knee osteoarthritis: A Markov model-based analysis |
| title_short | Economic evaluation of acupuncture as an adjunctive treatment with usual care for mild-to-moderate knee osteoarthritis: A Markov model-based analysis |
| title_sort | economic evaluation of acupuncture as an adjunctive treatment with usual care for mild to moderate knee osteoarthritis a markov model based analysis |
| topic | Acupuncture Economic evaluation Knee osteoarthritis Korean medicine Markov model |
| url | http://www.sciencedirect.com/science/article/pii/S2213422023000616 |
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