Economic analysis of acupuncture for migraine prophylaxis

Figures & data

Table 1 Unit cost

Type of costs	€a
Treatment
Acupuncture (cost out-of-pocket)
Acupuncture package (an initial visit, five acupuncture sessions, and a check-up visit)	166.0
Acupuncture follow-up session	16.6
Medication, package (reimbursement/co-payment)b	–c
Health care service, unit	0.04
Productivity/income loss, working day	24.52
Travels, km	0.14

Notes:

a 1 EUR = 27.05 CZK.

b Prescription and over-the-counter drugs were reimbursed based on the Czech National Drug Price List of 2015/2016²³ and priced at the average price calculated from the actual retail prices obtained from a sample of retail and hospital pharmacies in the study location in 2015/2016.

c The unit cost depends on the type of medication and so an average price cannot be established.

Table 2 Direct and indirect cols

Direct costs		Indirect costs
Medical	Nonmedical
Medication Outpatient visits Acupuncture visits Emergency visits Adverse drug reactions Paying third party	Travel costs Patient’s perspective	Loss of income Productivity loss Society’s perspective
Outpatient visits Medication reimbursement Acupuncture visits Emergency visits Adverse drug reactions	Medication (drug surcharge, over-the-counter drugs) Travel costs Loss of income Acupuncture visits	Productivity loss

Note: Costs dividing data from Drummond et al¹⁶ and Maresova et al.²⁰

Table 3 Baseline patient characteristics

Characteristics	Acupuncture group N=42	Control group N=44
Age (years)
Mean (SD)	45.6 (12.8)	46.5 (10.3)
Median	47	47.5
Female, n (%)	37 (88)	39 (89)
Positive family history of migraine, n (%)	24 (57)	29 (66)
Duration of migraine (years)
Mean (SD)	26.9 (12.9)	23.0 (14.1)
Median	27.5	20.0
Comorbidity, n (%)	23 (54.8)	23 (52.3)
Smokers, n (%)	9 (21)	5 (11)
Migraine days
Frequency (no. per month)	11.97 (6.6)	12.1 (9.2)
Duration (hours)	12.2 (15.3)	10 (11.4)
Intensity, VAS (mm)	5.2 (1.3)	5.4 (1.8)
Drug consumption (ATC/DDD)
Rescue medication, mean (SD)	14.8 (14.3)	11.5 (11.8)
Prophylactic medication, mean (SD)	9.6 (11.9)	7.2 (11.9)
Migraine attack (no per month)	6.4 (2.4)	6.0 (2.7)
Migraine disability assessment score	48.9 (38.1)	52.9 (31.9)
Employees (during working hours), n (%)	17 (40.5)	23 (52.3)
Employees (unpaid hours), n (%)	3 (7.1)	5 (11.4)
Place of residency (local patients), n (%)	9 (21.4)	16 (36.4)
Employees (during working hours), n (%)	17 (40.5)	23 (52.3)

Abbreviations: ATC/DDD, anatomical therapeutic classification/defined daily dose; VAS, visual analog scale.

Table 4 Mean use of resources during a 3-month acupuncture treatment and a 6-month follow-up

	Acupuncture group N=42			Control group N=44			P-value
Baseline year	N	Mean	SD	N	Mean	SD
Rescue/prophylactic medication (ATC/DDD)a	42	14.8/9.6	(14.3/11.9)	44	11.5/7.2	(11.8/11.9)	NS
Outpatient visits, n	42	1.0	0.7	44	1.0	0.8	NS
Productivity loss, working days	42	0.1	0.1	44	0.1	0.2	NS
Loss of income, unpaid working days	42	0.0	0.1	44	0.0	0.1	NS
Emergency visits	42	0.4	0.5	42	0.3	0.6	NS
Hospitalization	40	0.0	0.0	41	0.0	0.0	NS
Adverse drug reactions, n (%)	41	9	(22.0)	41	10	(24.4)	NS
Acupuncture treatment (3 months)
Rescue medication (ATC/DDD)a	42	26.1	41.4	42	26.8	27.5	NS
Acupuncture visits, n	42	13.5	0.7
Productivity loss, working days	42	0.8	1.4
Loss of income, unpaid working days	42	0.3	0.9
Outpatient visits, n	42	1.0	1.0	42	1.0	0.9	NS
Productivity loss, working days	42	0.1	0.2	42	0.1	0.1	NS
Loss of income, unpaid working days	42	0.0	0.1	42	0.0	0.1	NS
Emergency visits	42	0.1*	0.4	42	0.2	0.5	NS
Hospitalization	42	0.0	0.0	42	0.0	0.0	NS
Adverse drug reactions, n (%)	42	2	(4.8)	40	6	(15.0)	NS
6-month follow-up
Rescue medication (ATC/DDD)a	40	26.6	50.8	41	28.4	31.9	NS
Outpatient visits, n	40	0.7	0.7	41	1.0	1.1	NS
Productivity loss, working days	40	0.0*	0.1	41	0.1	0.2	NS
Loss of income, unpaid working days	40	0.0	0.0	41	0.0	0.1	NS
Emergency visits	40	0.3	0.6	39	0.4	0.7	NS
Hospitalization	40	0.0	0.0	37	0.0	0.0	NS
Adverse drug reactions, n (%)	39	7	(17.9)	38	8	(21.1)	NS

Notes:

a Rescue medication (ATC: N02, M01, R06).

* Level of significance 0.05 (between-group comparison, unpaired t-test, Mann–Whitney test, Fisher’s exact test). Level of significance 0.05 (within-group comparison, paired t-test, Wilcoxon signed-rank test).

Abbreviations: ATC/DDD, anatomical therapeutic classification/defined daily dose; NS, nonsignificant.

Table 5 Comparison of mean baseline and overall costs after a 3-month acupuncture treatment and a 6-month follow-up

	Acupuncture group (N=42), cost per patient			Control group (N=44), cost per patient			Bootstrap t P-value (one tailed)
	N	Mean	95% CI	N	Mean	95% CI	P-value	Meancontrol-Meanacup
Baseline year
Direct costs
Medication reimbursement	42	8.6	(2.8, 14.4)	44	16.4	(0.4, 32.4)	0.89	7.8
Medication co-payment	42	9.8	(3.8, 16)	44	5.5	(2.2, 8.8)	0.89	−4.3
Outpatient visits	42	5.0	(4, 6)	44	4.6	(3.7, 5.6)	0.71	−0.4
Emergency visits	42	6.4	(3.5, 9.2)	44	5.7	(2.6, 8.6)	0.64	−0.7
Adverse drug reactions	42	0.6	(-0.5, 1.8)	44	0.2	(-0.1, 0.6)	0.74	−0.3
Travel costs	42	7.5	(4.3, 10.9)	44	6.8	(3.6, 9.9)	0.62	−0.7
Direct total costs	42	38.1	(-27.8, 65.2)	44	39.4	(19.8, 58.7)	0.45	1.2
Indirect costs
Productivity loss	42	128.3	(57.2, 199.9)	44	249.2	(68, 430.7)	0.24	120.9
Loss of income	42	6.0	(-2.8, 15.5)	44	4.1	(-2.1, 10.3)	0.65	−1.9
Indirect total costs	42	134.3	(61.1, 208.7)	44	253.4	(70.9, 439.9)	0.27	119.0
Total costs	42	172.5	(100.4, 282.2)	44	292.8	(110.8, 474.4)	0.26	120.3
Acupuncture treatment (3 months)
Direct costs
Medication reimbursement	42	15.8	(5.4, 27)	44	41.5	(−2.0, 84.3)	0.12	25.6
Medication co-payment	42	21.8	(5.9, 37.7)	44	11.1	(4.7, 17.8)	0.89	−10.7
Acupuncture visits, patients	42	308.5	(304.8, 312.1)
Acupuncture visits, third-party payer	42	25.1	(25.1, 25.1)
Travel acupuncture costs	42	120.8	(84.9, 155.5)
Outpatient visits	42	4.0	(2.6, 5.2)	44	4.1	(3.1, 5.1)	0.45	0.1
Travel costs	42	7.8	(4, 11.8)	44	3.7	(2.2, 5.2)	0.97	−4.1
Emergency visits	42	1.8	(0, 3.9)	44	2.9	(1.1, 4.8)	0.20	1.1
Adverse drug reactions	42	0.4	(-0.4, 1.2)	44	0.9	(-0.1, 1.9)	0.24	0.4
Direct total costs (with acupuncture costs)	42	506.4	(463.7, 548.9)	44	64.4	(20.7, 108.2)	0.13	−441.9
Direct total costs (without acupuncture costs)	42	51.9	(29.1, 74)	44	64.4	(24, 105.6)	0.30	12.5
Indirect costs
Loss of income (acupuncture)	42	12.3	(0.1, 24.9)
Productivity loss (acupuncture)	42	39.9	(20.3, 60.2)
Loss of income	42	14.0	(-12.5, 39.9)	44	4.0	(-2.3, 10.4)	0.76	−10.0
Productivity loss	42	123.3	(-19.1, 271.1)	44	216.3	(-1.4, 445.1)	0.24	92.9
Indirect total costs (with acupuncture costs)	42	189.7	(245.1, 564.3)	44	220.3	(-6.6, 452.1)	0.90	30.6
Indirect total costs (without acupuncture costs)	42	137.4	(-2.1, 275.9)	44	220.3	(-1.7, 449.4)	0.26	82.9
Total costs (with acupuncture costs)	42	696.1	(737.4, 1,085.4)	44	284.7	(32.9, 523.7)	0.26	−411.3
Total costs (without acupuncture costs)	42	189.3	(44.1, 334.4)	44	284.7	(34, 533.9)	0.25	95.4
6-month follow-up
Direct costs
Medication reimbursement	42	15.5	(6.6, 24.3)	44	44.8	(−5.8, 94.6)	0.12	29.3
Medication co-payment	42	20.7	(2.9, 39)	44	12.0	(4.1, 19.7)	0.81	−8.6
Outpatient visits	42	3.2	(2.2, 4.2)	44	3.7	(2.6, 4.9)	0.25	0.5
Emergency visits	42	4.2	(1.1, 7.4)	44	6.1	(2.3, 9.6)	0.22	1.8
Adverse drug reactions	42	0.1	(-0.1, 0.5)	44	0.3	(−0.3, 1.1)	0.28	0.2
Travel costs	42	7.7	(2.2, 2)	44	4.6	(1.8, 0.0295)	0.86	−3.1
Direct total costs	42	51.7	(28, 76)	44	71.9	(21.8, 124.4)	0.23	20.1
Indirect costs
Loss of income	42	3.6	(-3, 10.2)	44	8.3	(0.5, 15.9)	0.18	4.6
Productivity loss	42	10.2	(2.7, 18)	44	51.6	(−10.2, 117.8)	0.085	41.4
Indirect total costs	42	13.9	(6.6, 24.3)	44	59.9	(−5.8, 94.6)	0.075	46.0
Total costs	42	65.7	(2.9, 39)	44	131.9	(4.1, 19.7)	0.071	66.2

Note: Mean_control - Mean_acup, difference between the control group and the group with acupuncture treatment.

Table 6 Sensitivity analysis

Acupuncture group N=42	Control group N=44		Bootstrap t, P-value (one tailed)
	Mean	95% CI	Mean	95% CI	P-value
Direct costs (min price of acupuncture treatment in the Czech Republic)	398.0	(355.2, 440.6)	64.4	(20.7, 108.2)	0.999
Total cost (min price of acupuncture treatment in the Czech Republic)a	805.7	(627, 979.8)	284.7	(32.9, 523.7)	0.970
Direct costs (max price of acupuncture treatment in the Czech Republic)	764.9	(725.8, 806.2)	64.4	(20.7, 108.2)	0.999
Total cost (max price of acupuncture treatment in the Czech Republic)a	1,172.6	(1,000.9, 1,346.9)	284.7	(32.9, 523.7)	0.999

Notes:

a Costs are expressed in 2015/2016 EURO and are varying from €11.0 to €35.0 (cost of acupuncture session) at 0% discount rate.

General Health Insurance Fund of the Czech Republic Available from: https://www.vzp.cz/poskytovatele/ciselniky/hromadne-vyrabene-lecive-pripravky-a-potraviny-pro-zvlastni-lekarske-ucely/archivAccessed September 23, 2018

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