Chronic headaches as it was as mig...

Chronic headaches as it was as migraine and tension headaches are responsible for significant direct health care sumptuousnesss and even larger indirect outlays because of lost productivity and tonnages on patients and families. Acupuncture has been propos as an alternative treatment for chronic headaches, on the contrary the cost effectiveness of this approach has not been determined. Wonderling and colleagues studied more than 400 patients recruited from general practices in England and Wales to determine the efficacy and costlinesss of acupuncture for chronic headache.

Patients who reported at least pair headaches per month were assigned randomly to usual care or up to 12 acupuncture treatments from one side of to the other a three-month period. Data were gathered onward the type and severity of headaches, as well as demographic information and require to be paid [i]or[/i] undergones paid by the patient for headache management. Patients complet a standardized measure of health-related quality of life at baseline, and three and 12 month after starting the study

At baseline, the 136 patients assigned to acupuncture were similar to the 119 patients assigned to usual care in all important variables. Eighteen patients did not attend their acupuncture sessions. The remaining patients had an average of 42 hours of acupuncture therapy. Thirty patients assigned to acupuncture and sum of two units patients in the control clump visited an acupuncturist for additional treatment during the research Patients assigned to the acupuncture dispose showed a statistically significant improvement in health from one side of to the other the year and had small on the other hand significant reductions in physician visits and use of complementary or alternative medications. The total costlinesss were higher in the acupuncture cluster because of acupuncture practitioners' expenses The researchers calculated the additional splendor for each quality-adjusted life year (QALY) gained from acupuncture to be just above $16,300.

The authors gather that acupuncture for chronic headache is relatively expense effective and compares favorably with the approximately $28400 estimated richness of oral caffeine plus ergotamine.

ANNE D WALLING, MD

Wonderling D et al. charge effectiveness analysis of a randomised trial of acupuncture for chronic headache in primary care. BMJ March 15 2004;328:747-9

EDITOR'S NOTE: one as well as the other the National Institutes of Health and the Cochrane Database reviews provide cautious support for acupuncture treatment of headache (predominantly migraine). In a condition with approximately 25 percent placebo answer a significant benefit from acupuncture could be anticipated, hence the two organizations call for large, rigorously controll trials to establish certification of benefit beyond the placebo replication (1) If acupuncture is beneficial, the cost-effectiveness calculations in the United States could be complicated because of the many headache medications available and a complicated pricing structure. The comment in this article that changing from oral caffeine and ergotamine to suma triptan had a charge per QALY gained of more than $28000 highlights the enormous expenses of migraine medication. It also reminds me of an thoroughly good study (2) in which suitably dosed aspirin plus metoclopramide was equivalent, if not superior, to sumatriptan in acute migraine, and presumably greatly more cost effective. Migraine is an idiosyncratic condition in which the in the greatest degree cost-effective regimen is the common that works best for the individual patient.--A.D.W.

REFERENCES

(1) Zoorob R Morelli V Larzelere M Complementary and alternative medicine. AAFP domestic circle study self-assessment; FP essentials 293 Leawood, Kan.: American Academy of Family Physicians, 2003

(2) Tfelt-Hansen P Henry P Mulder LJ Scheldewaert RG Schoenen J Chazot G The effectiveness of combined oral lysine acetylsalicylate and metoclopramide compared with oral sumatriptan for migraine. Lancet 1995;346:923-6

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