Complimentary medicine can save you money

Acupuncture and some dietary supplements can reduce health care costs for some of the most common and disabling health conditions afflicting Australians, according to a report prepared by a top economics consultancy.1,a

Access Economics was commissioned by the National Institute of Complementary Medicine (NICM; see related article) to conduct an important research project to examine the cost-effectiveness analyses of complementary therapies as they are used in the community compared to conventional treatment.

Cost-effectiveness (CE) analysis has become the gold standard for the government and policy makers to measure ‘value for money’ of medical treatments and other interventions. Results from the recent research undertaken by Access Economics show the potential role that complementary medicines can play in improving the health of Australians in a cost-effective manner.

Access Economics was asked by NICM to assess five treatments that had “a reasonable body of evidence for safety and efficacy” using Australian statistics and cost data:

1. Acupuncture for low back pain

2. St John’s wort for mild-to-moderate depression

3. omega–3 fish oils for secondary prevention of heart disease

4. omega–3 fish oils to reduce NSAID use in rheumatoid arthritis

5. A proprietary herbal medicine blend for pain and inflammation of osteoarthritis.

Acupuncture for chronic low back pain was found to be cost-effective if used in conjunction with standard care, such as medication, physiotherapy, exercises and education. When used alone, there was a significant improvement in pain but it was relatively short-lived. When the common comorbidity of depression was considered, acupuncture did save more money and have significantly better pain outcomes than standard care.

However, low back pain is estimated to affect at least one in 10 Australian adults and is notorious as a major cause of absenteeism and lost productivity in the workforce –– indirect costs that Access Economics did not calculate in this or its other analyses. This means that “these results may be conservative” and the savings from acupuncture would double, “or more than double” if indirect costs, such as carer expenses, were included.

Nearly $50 million could be saved each year by people with mild-to-moderate depression using St John’s wort instead of standard antidepressants, the report said in one of its strongest findings. Highlighted was the fact that St John’s wort “dominated” the pharmaceutical mainstays because the unit cost was about 40c lower per day for St John’s wort, and also reduced disease burden due to the fact that fewer patients withdrew from the treatment. The unit costs were based on official and online pharmacy data and it was stated that even if the cost of St John’s wort tripled due to product standardisation and medical supervision to avoid interactions, the herb would still trump antidepressants due to better compliance.

Fish oils were found to be highly cost effective as an adjunctive therapy in preventing further morbidity and mortality among people who’d already experienced a heart attack, after comparing the mortality and morbidity among people who had no fish oils within three months of a heart attack. Omega–3 supplements would cost individuals just $128 per year for their benefit, and mean nearly 22 less days lost due to disability.

Fish oils did not, however, save money by reducing a rheumatoid arthritis patient’s reliance on NSAIDs, despite the known side effects of cox-2 inhibitors. Assuming a model where omega–3 supplements were used for 12 months as adjunctive therapy to three months’ use of NSAIDs, the gains in quality in life were offset by fish oil costing slightly more than PBS-listed anti-inflammatories.

Missing from all the calculations were indirect savings –– from lost productivity, absenteeism, presenteeism and treating comorbidities (other than depression in the back-pain/acupuncture study) –– that use of complementary therapies could offer. Professor Alan Bensoussan, Executive Director of NICM, said these would increase cost effectiveness but that the treatments were already cost effective despite GST being levied on them.

In 2004, cost-benefit economic analysis was “a relative newcomer in complementary medicine research” according to Professor Stephen P Myers, Foundation Director of NatMed Research, the Natural and Complementary Medicine Research Unit in the School of Health and Human Sciences at Southern Cross University. He added that natural treatments that were shown to be effective therapeutically were then “often extremely cost-effective in comparison to conventional treatment”.

This report to NICM from a leading economics consultancy, known to Australian practitioners as one cited by governments for policy costings, shows how far the field has come in six short years. Although it explores only specific interventions to specific diagnosed medical conditions, it finally ‘ticks the box’ so critical to bean-counting allocators of funding: that complementary medicine saves money.

More posts on my website www.nrchi.com.au/blog

REFERENCES

Reference

1. Access Economics P/L. Cost effectiveness of complementary medicines. August 2010. URL: www.accesseconomics.com.au/publicationsreports/getreport.php?report=248&id=317, accessed 30.9.10.

2. Myers SP. Comment. Journal Digest 2. J Complement Med 2004;3(2)(Suppl 2):29.

a. In Australia, complementary medicines are not generally registered for use in the treatment of serious medical conditions. This report provides important information on complementary medicine research. It is not meant to promote the use of complementary medicines for self-treatment of serious medical conditions that require proper medical diagnosis and management by healthcare professionals.