Cost-Effectiveness of Acupuncture Needling for Older Adults With Chronic Low Back Pain

STUDY DESIGN: Preplanned economic evaluation alongside a clinical trial. OBJECTIVE: Determine the 1-year cost-effectiveness from health care sector and Medicare perspectives of adding either standard acupuncture (SA; ≤15 treatment sessions over 12 wk) or enhanced acupuncture (EA; SA plus ≤ 6 additional sessions) to usual medical care (UMC) versus UMC alone. SUMMARY OF BACKGROUND DATA: Chronic low back pain (CLBP) is common and expensive to treat largely due to the use of non-guideline-concordant pharmaceuticals and procedures. CLBP is also more common in older populations. Acupuncture has been shown to be effective and cost-effective for CLBP, but no studies have focused specifically on older adults. METHODS: Cost-utility and cost-effectiveness analyses comparing SA and EA to UMC using data from a randomized trial across three US health care systems. Bias-corrected and accelerated bootstrap techniques were used to generate 95% CIs. RESULTS: EA (n=225) reduced annual back pain-related health care sector costs by $491 (CI: -$2861, $1144) per participant versus UMC (n=225), and reduced Medicare-reimbursed costs by $421 (CI: -$2707, $1249) per participant. These cost savings came with a statistically and clinically significant gain in quality-adjusted life-years (QALYs; 0.037; CI: 0.013, 0.062), and a significant increase in the percentage of participants achieving a clinically meaningful improvement (CMI) in their Roland-Morris Disability Questionnaire scores (18.5% points; CI: 9.0%, 27.9%). SA (n=222) was more expensive than UMC; the incremental cost-effectiveness ratio from the health care sector perspective was $52,897/QALY. The QALY gains (0.014; CI: -0.014, 0.043) and increase in percentage of participants with a CMI (6.9%; CI: -2.7%, 16.4%) in SA versus UMC were not statistically significant. CONCLUSION: EA was cost-saving and SA may be cost-effective from the health care sector and Medicare perspectives compared with UMC for older adults with CLBP in three large health care systems in California and Washington State.Level II.