Electroacupuncture with Usual Care for Patients with Non-Acute Pain after Back Surgery: Cost-Effectiveness Analysis Alongside a Randomized Controlled Trial
Abstract
:1. Introduction
2. Materials and Methods
2.1. Randomization Design and Participants
2.2. Ethics
2.3. Interventions
2.3.1. Usual Care
2.3.2. Electroacupuncture Collaboration
2.3.3. Permitted and Prohibited Concomitant Treatments
2.4. Utility Measure and Valuation
2.5. Resource Use and Cost Measures
2.6. Missing Data Analysis
2.7. Cost-Utility Analyses
2.8. Sensitivity Analysis
3. Results
3.1. Costs
3.2. Utilities
3.3. Incremental Cost-Effectiveness Ratio (ICER)
3.4. Sensitivity Analyses
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Variables | Usual Care (N = 53) | Electroacupuncture (N = 53) | p-Value | |||
---|---|---|---|---|---|---|
Mean, SD or N, Percent | Mean, SD or N, Percent | |||||
Sex | Male (N, %) | 26 | 49.06 | 27 | 50.94 | 0.846 |
Female (N, %) | 27 | 50.94 | 26 | 49.06 | ||
Age | 46.08 | 14.56 | 45.91 | 13.09 | 0.950 | |
Income (KRW) | Less than 10 million | 8 | 15.09 | 6 | 11.32 | 0.445 |
10–50 million | 25 | 47.17 | 23 | 43.40 | ||
50–100 million | 19 | 35.85 | 19 | 35.85 | ||
More than 100 million | 1 | 1.89 | 5 | 9.43 | ||
BMI | 23.9 | 3.89 | 23.9 | 3.06 | 0.996 | |
OP hospital | Clinic | 22 | 41.51 | 16 | 30.19 | 0.340 |
Hospital | 23 | 43.40 | 24 | 45.28 | ||
General hospital | 8 | 15.09 | 13 | 24.53 | ||
Carer | None | 5 | 9.43 | 5 | 9.43 | 0.631 |
Family | 37 | 69.81 | 41 | 77.36 | ||
Family and carer | 4 | 7.55 | 1 | 1.89 | ||
Carer | 7 | 13.21 | 6 | 11.32 | ||
Admission day | 20.43 | 19.71 | 34.35 | 68.08 | 0.156 | |
Operation cost | 4,403,529 | 3,183,233.00 | 7,941,085 | 21,800,000.00 | 0.253 | |
Direct medical cost | 1,725,472 | 1,965,332.00 | 3,798,113 | 5,806,710.00 | 0.016 | |
Care time | 319.7 | 526.10 | 262 | 333.90 | 0.502 | |
Week work time | 48.51 | 23.83 | 50.06 | 24.62 | 0.747 | |
Absenteeism (day) | 32.26 | 86.25 | 27.55 | 71.10 | 0.774 | |
Presenteeism (percent) | 6.151 | 2.38 | 6.039 | 2.58 | 0.819 | |
EQ-5D (baseline) | 0.72 | 0.13 | 0.74 | 0.15 | 0.296 | |
EQ-VAS | 62.15 | 11.31 | 60.58 | 14.26 | 0.532 |
Variables | Follow-Up Time | Usual Care (n = 43) | Electroacupuncture (n = 40) | ||
---|---|---|---|---|---|
Mean | SD | Mean | SD | ||
EQ-5D | Baseline | 0.741 | 0.11 | 0.755 | 0.155 |
4 weeks | 0.771 | 0.105 | 0.797 | 0.095 | |
8 weeks | 0.782 | 0.108 | 0.810 | 0.097 | |
12 weeks | 0.791 | 0.105 | 0.820 | 0.117 | |
24 weeks | 0.804 | 0.101 | 0.803 | 0.15 | |
Direct medical costs (KRW) | 1–4 weeks | 119,355 | 24,013 | 230,085 | 50,409 |
5–8 weeks | 2474 | 8552 | 11,320 | 69,990 | |
9–12 weeks | 1228 | 6937 | 6285 | 34,834 | |
13–24 weeks | 37,660 | 162,502 | 83,875 | 351,700 | |
Direct non-medical costs (KRW) | 1–4 weeks | 143,365 | 63,631 | 130,000 | 6236 |
5–8 weeks | 125,780 | 56,194 | 116,210 | 6230 | |
9–12 weeks | 125,909 | 56,212 | 116,796 | 8160 | |
13–24 weeks | 126,637 | 56,265 | 117,868 | 9596 | |
Productivity costs (KRW) | 1–4 weeks | 610,361 | 130,076 | 600,011 | 142,028 |
5–8 weeks | 330,598 | 191,156 | 338,616 | 215,182 | |
9–12 weeks | 313,959 | 173,367 | 313,205 | 225,202 | |
13–24 weeks | 1,106,316 | 742,713 | 1,021,153 | 693,301 |
Resources | Usual Care (n = 43) | Electroacupuncture (n = 40) | Mean Difference | |||
---|---|---|---|---|---|---|
Mean | SD | Mean | SD | Mean | 95% CI | |
QALYs (6 months) | 0.361 | 0.041 | 0.370 | 0.047 | 0.009 | (−0.010, 0.028) |
Direct medical costs | 160,718 | 159,735 | 331,565 | 374,476 | 170,847 | (46,645, 295,049) |
Direct non-medical costs | 521,691 | 231,482 | 480,873 | 26,190 | −40,818 | (−114,105, 32,468) |
Productivity costs | 2,361,235 | 1,044,315 | 2,272,985 | 1,142,409 | −88249.4 | (−565,821, 389,322) |
Total costs (LSP) | 682,409 | 274,958 | 812,438 | 382,578 | 130,029 | (−14,718, 274,776) |
Total costs (SP) | 3,043,643 | 1,098,816 | 3,085,423 | 1,338,813 | 41,780 | (−491,576, 575,136) |
Analyses | Perspectives | Treatments | Cost | Delta Cost | QALYs | Delta QALYs | ICER |
---|---|---|---|---|---|---|---|
ITT | SP | UC (N = 53) | 3,052,480 | 0.35836 | |||
EA (N = 53) | 3,117,082.6 | 64,602.56 | 0.367526 | 0.009 | 7,048,602.88 | ||
LSP | UC (N = 53) | 683,687 | 0.358677 | ||||
EA (N = 53) | 827,131 | 143,444 | 0.366774 | 0.008 | 17,716,572.4 | ||
PP | SP | UC (N = 43) | 3,043,643 | 0.361 | |||
EA (N = 40) | 3,085,423 | 41,780 | 0.37 | 0.009 | 4,674,999.16 | ||
LSP | UC (N = 43) | 682,409 | 0.361 | ||||
EA (N = 40) | 812,438 | 130,029 | 0.37 | 0.009 | 14,549,698.4 |
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Kim, N.; Shin, K.-M.; Seo, E.-S.; Park, M.; Lee, H.-Y. Electroacupuncture with Usual Care for Patients with Non-Acute Pain after Back Surgery: Cost-Effectiveness Analysis Alongside a Randomized Controlled Trial. Sustainability 2020, 12, 5033. https://doi.org/10.3390/su12125033
Kim N, Shin K-M, Seo E-S, Park M, Lee H-Y. Electroacupuncture with Usual Care for Patients with Non-Acute Pain after Back Surgery: Cost-Effectiveness Analysis Alongside a Randomized Controlled Trial. Sustainability. 2020; 12(12):5033. https://doi.org/10.3390/su12125033
Chicago/Turabian StyleKim, NamKwen, Kyung-Min Shin, Eun-Sung Seo, Minjung Park, and Hye-Yoon Lee. 2020. "Electroacupuncture with Usual Care for Patients with Non-Acute Pain after Back Surgery: Cost-Effectiveness Analysis Alongside a Randomized Controlled Trial" Sustainability 12, no. 12: 5033. https://doi.org/10.3390/su12125033