Integrative medicine for back and neck pain: Exploring cost-effectiveness alongside a randomized clinical pilot trial

IntroductionIntegrative medicine (IM), the integration of complementary therapies (CTs) and conventional care, is common despite a scarce evidence base of cost-effectiveness. This study explored the cost-effectiveness of IM from a healthcare perspective comparing conventional primary care to a comprehensive IM model in the management of patients with chronic non-specific back/neck pain.MethodsData on clinical management (planning and delivering IM), resource use (conventional care, CTs, prescription and non-prescription analgesics) and outcome effectiveness (SF-6D) were derived alongside a pragmatic randomized clinical pilot trial (n = 80) with 16 weeks follow-up. Costs and effects, i.e. quality-adjusted life years (QALYs), were estimated over different time periods and willingness-to-pay thresholds. Net monetary benefit and bootstrapping methods were used to address uncertainty in the cost-effectiveness analyses.ResultsThe IM model, on average integrating 7 CT sessions with conventional primary care over 10 weeks, resulted in increased QALYs, somewhat higher cost of health care provision but a reduced cost of using health care resources, including less use of analgesics compared to conventional primary care. The costs/QALY ranged between €24,000 and 41,000.ConclusionGiven the threshold value of €50,000 per QALY gained, and a remaining effect of one year, it is indicated that IM might be cost-effective compared with conventional primary care. Future cost-effectiveness studies of IM should be carried out from a societal perspective and should be based on large scale pragmatic randomized clinical trials.