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Cost-effectiveness of acupuncture versus standard care for pelvic and low back pain in pregnancy: A randomized controlled trial

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  • Stephanie Nicolian
  • Thibault Butel
  • Laetitia Gambotti
  • Manon Durand
  • Antoine Filipovic-Pierucci
  • Alain Mallet
  • Mamadou Kone
  • Isabelle Durand-Zaleski
  • Marc Dommergues

Abstract

Objective: To assess the cost-effectiveness of acupuncture for pelvic girdle and low back pain (PGLBP) during pregnancy. Design: Pragmatic-open-label randomised controlled trial. Setting: Five maternity hospitals Population: Pregnant women with PGLBP Method: 1:1 randomization to standard care or standard care plus acupuncture (5 sessions by an acupuncturist midwife). Main outcome measure: Efficacy: proportion of days with self-assessed pain by numerical rating scale (NRS) ≤ 4/10. Cost effectiveness (societal viewpoint, time horizon: pregnancy): incremental cost per days with NRS ≤ 4/10. Indirect non-healthcare costs included daily compensations for sick leave and productivity loss caused by absenteeism or presenteeism. Results: 96 women were allocated to acupuncture and 103 to standard care (total 199). The proportion of days with NRS ≤ 4/10 was greater in the acupuncture group than in the standard care group (61% vs 48%, p = 0.007). The mean Oswestry disability score was lower in the acupuncture group than with standard care alone (33 versus 38, Δ = 5, 95% CI: 0.8 to 9, p = 0.02). Average total costs were higher in the control group (€2947) than in the acupuncture group (€2635, Δ = —€312, 95% CI: -966 to +325), resulting from the higher indirect costs of absenteeism and presenteeism. Acupuncture was a dominant strategy when both healthcare and non-healthcare costs were included. Costs for the health system (employer and out-of-pocket costs excluded) were slightly higher for acupuncture (€1512 versus €1452, Δ = €60, 95% CI: -272 to +470). Conclusion: Acupuncture was a dominant strategy when accounting for employer costs. A 100% probability of cost-effectiveness was obtained for a willingness to pay of €100 per days with pain NRS ≤ 4.

Suggested Citation

  • Stephanie Nicolian & Thibault Butel & Laetitia Gambotti & Manon Durand & Antoine Filipovic-Pierucci & Alain Mallet & Mamadou Kone & Isabelle Durand-Zaleski & Marc Dommergues, 2019. "Cost-effectiveness of acupuncture versus standard care for pelvic and low back pain in pregnancy: A randomized controlled trial," PLOS ONE, Public Library of Science, vol. 14(4), pages 1-16, April.
    • Handle: RePEc:plo:pone00:0214195
    DOI: 10.1371/journal.pone.0214195
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    References listed on IDEAS

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    3. Heckman, James, 2013. "Sample selection bias as a specification error," Applied Econometrics, Russian Presidential Academy of National Economy and Public Administration (RANEPA), vol. 31(3), pages 129-137.
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