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Savona-Ventura C, Mahmood T. The role of traditional complementary physical interventions in obstetrics – A scientific review commissioned by the European board and college of obstetrics and gynaecology (EBCOG). Eur J Obstet Gynecol Reprod Biol 2022; 279:84-87. [DOI: 10.1016/j.ejogrb.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hamidzadeh A, Tavakol Z, Maleki M, Kolahdozan S, Khosravi A, Kiani M, Vaismoradi M. Effect of acupressure at the BL67 spot on the spontaneous rotation of fetus with breech presentation: A randomized controlled trial. Explore (NY) 2021; 18:567-572. [PMID: 34764014 DOI: 10.1016/j.explore.2021.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 10/02/2021] [Accepted: 10/16/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Breech is a common fetal presentation in preterm pregnancies. This study aimed to investigate the effect of acupressure at the BL67 point on the spontaneous rotation of fetus with breech presentation. METHODS An unblind, two-armed randomized controlled trial was carried out from September 2017 to April 2020. Research participants were 138 pregnant women at 32 to 35 weeks of gestational age that had fetal breech presentation confirmed by ultrasound. They were randomly assigned into intervention and control groups (n=69 in each group). The intervention group received acupressure at the BL67 point on both feet for 10 minutes daily and for two consecutive weeks. The control group received routine care. Demographic and midwifery data questionnaires were used for data collection. RESULTS The spontaneous rotation of fetus with breech presentation into cephalic was observed in the majority of participants in the intervention group (82.6%) compared to the control group (17.4%) (p<0.001). Statistically significant differences in the fetal presentation at delivery was observed between the groups (84.1% cephalic vs. 18.8% breech, p<0.001). Regarding the type of delivery, cesarean section was reported mostly (85.5%) in the control group compared to the intervention group (21.7%) (p<0.001). However, the first- and fifth-minute Apgar scores of newborns had no statistically significant differences between the groups (p=0.773). CONCLUSION It is suggested to incorporate acupressure at the BL67 point into the care process for pregnant women to help with the reduction of the rate of cesarean section and avoid its related complications.
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Affiliation(s)
- Azam Hamidzadeh
- Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran.
| | - Zeinab Tavakol
- Community-Oriented Nursing Midwifery Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran.
| | - Maryam Maleki
- Pediatric and Neonatal Intensive Care Nursing Education Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sakineh Kolahdozan
- Sexual Health and Fertility Research Center, Shahroud University of Medical Sciences, Shahroud, Iran.
| | - Ahmad Khosravi
- Center for Health related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran.
| | - Mahdieh Kiani
- School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran.
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Sarsmaz K, Kulah BB, Orgul G, Tonyalı NV, Yucel A, Tekin OM. Effectiveness of Moxibustion for Breech Presentation: A Prospective Study. Z Geburtshilfe Neonatol 2021; 226:112-120. [PMID: 34528235 DOI: 10.1055/a-1579-1436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the moxibustion for turning fetuses from breech to vertex presentation. MATERIALS AND METHODS This was a single-center prospective study. All pregnant women carrying a fetus in breech presentation between the 32 and 35 gestational weeks were offered moxibustion application. The primary outcomes were vertex presentation at 37 weeks of gestation, vertex presentation at birth, and vaginal birth rates. A secondary analysis was performed to understand the effect of parity, type of breech presentation, body mass index (BMI), placental location, gender, and fetal birth weight on the presentation at birth. RESULTS There were 63 cases in the study group and 245 cases in the control group. The rate of vertex presentation at term was found to be higher in the moxibustion group compared to controls (66.7 vs. 48.2%, p=0.022). There were 45 (71.4%) and 131 (53.5%) fetuses with vertex presentation at birth in the study and control groups, respectively (p=0.020). Overall, vaginal delivery rate was higher in the study group (50.8 vs. 37.1%, p=0.048). Multiparity and higher birth weight were associated with increased rates of vertex presentation in the moxibustion and control groups. CONCLUSION Moxibustion application increased the rate of vertex presentation at birth and also vaginal delivery rate compared with expectant management. Offering moxibustion between the 32nd and 36th week of gestation may provide women with a singleton fetus in breech presentation an opportunity for a vaginal birth.
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Affiliation(s)
- Kemal Sarsmaz
- Division of Perinatology, Department of Obstetrics and Gynecology, Etlik Zubeyde Hanim Women's Health Care, Training and Research Hospital, Ankara, Turkey
| | - Belkiz Berna Kulah
- Department of Anesthesiology, Etlik Zubeyde Hanim Women's Health Care, Training and Research Hospital, Ankara, Turkey
| | - Gokcen Orgul
- Division of Perinatology, Department of Obstetrics and Gynecology, Etlik Zubeyde Hanim Women's Health Care, Training and Research Hospital, Ankara, Turkey
| | - Nazan Vanlı Tonyalı
- Division of Perinatology, Department of Obstetrics and Gynecology, Etlik Zubeyde Hanim Women's Health Care, Training and Research Hospital, Ankara, Turkey
| | - Aykan Yucel
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Ozlem Moraloglu Tekin
- Department of Obstetrics and Gynecology, Turkish Ministry of Health, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
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Liao JA, Shao SC, Chang CT, Chai PYC, Owang KL, Huang TH, Yang CH, Lee TJ, Chen YC. Correction of Breech Presentation with Moxibustion and Acupuncture: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2021; 9:healthcare9060619. [PMID: 34067379 PMCID: PMC8224784 DOI: 10.3390/healthcare9060619] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 12/12/2022] Open
Abstract
Acupuncture-type interventions (such as moxibustion and acupuncture) at Bladder 67 (BL67, Zhiyin point) have been proposed to have positive effects on breech presentation. The aim of this systematic review and meta-analysis was to evaluate the effectiveness and safety of moxibustion and acupuncture in correcting breech presentation. We searched PubMed, MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), the Chinese Electronic Periodical Services (CEPS), and databases at ClinicalTrials.gov to identify relevant randomized controlled trials (RCTs). In this study, sixteen RCTs involving 2555 participants were included. Compared to control, moxibustion significantly increased cephalic presentation at birth (RR = 1.39; 95% CI = 1.21–1.58). Moxibustion also seemed to elicit better clinical outcomes in the Asian population (RR = 1.42; 95% CI = 1.21–1.67) than in the non-Asian population (RR = 1.20; 95% CI = 1.01–1.43). The effects of acupuncture on correcting breech presentation after sensitivity analysis were inconsistent relative to control. The effect of moxibustion plus acupuncture was synergistic for correcting breech presentation (RR = 1.53; 95% CI = 1.26–1.86) in one RCT. Our findings suggest that moxibustion therapy has positive effects on correcting breech presentation, especially in the Asian population.
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Affiliation(s)
- Jian-An Liao
- Department of Traditional Chinese Medicine, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan; (J.-A.L.); (T.-H.H.); (T.-J.L.)
| | - Shih-Chieh Shao
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan; (S.-C.S.); (C.-T.C.); (P.Y.-C.C.); (K.-L.O.)
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
- Center of Evidence-Based Medicine, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan;
| | - Chian-Ting Chang
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan; (S.-C.S.); (C.-T.C.); (P.Y.-C.C.); (K.-L.O.)
| | - Pony Yee-Chee Chai
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan; (S.-C.S.); (C.-T.C.); (P.Y.-C.C.); (K.-L.O.)
| | - Kok-Loon Owang
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan; (S.-C.S.); (C.-T.C.); (P.Y.-C.C.); (K.-L.O.)
| | - Tse-Hung Huang
- Department of Traditional Chinese Medicine, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan; (J.-A.L.); (T.-H.H.); (T.-J.L.)
| | - Chung-Han Yang
- Center of Evidence-Based Medicine, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan;
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Tsai-Jen Lee
- Department of Traditional Chinese Medicine, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan; (J.-A.L.); (T.-H.H.); (T.-J.L.)
| | - Yung-Chih Chen
- Center of Evidence-Based Medicine, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan;
- Division of General Internal Medicine, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan
- Correspondence: ; Tel.: +886-2-24329292
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Steel A, Hall H, Diezel H, Wardle J, Adams J. Filling the gaps in contemporary maternity care: The perceptions of complementary medicine practitioners providing care to women during pregnancy. Complement Ther Clin Pract 2019; 34:174-178. [DOI: 10.1016/j.ctcp.2018.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/29/2018] [Accepted: 11/29/2018] [Indexed: 12/23/2022]
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Borah BJ, Naessens JM, Glasgow AE, Bauer BA, Chon TY. Cost-effectiveness of acupuncture in an employee population: A retrospective analysis. Complement Ther Med 2017; 31:14-19. [PMID: 28434466 DOI: 10.1016/j.ctim.2017.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 12/06/2016] [Accepted: 01/12/2017] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To determine whether acupuncture is a cost-effective adjunct to usual care for Mayo Clinic employees and their dependents experiencing pain symptoms. DESIGN Retrospective review of the medical and billing records of 466 employee-patients and their dependents who had received acupuncture as part of their care and 466 propensity score-matched control patients. INTERVENTIONS Usual care in combination with acupuncture compared with usual care alone. MAIN OUTCOME MEASURES The primary outcome measure was the total costs of care for all medical care and pharmacy services incurred from 1year before the index visit to 14 months after the index date. Secondary outcomes included the number of hospital visits, total inpatient days, emergency department visits, primary care or general medicine office visits, specialty office visits, and physical therapy services. Pain scores (patient-rated scores from 0 to 10) were extracted from the medical record, if available. RESULTS Costs of care were similar between the 2 groups. No cost savings were noted for the acupuncture group. CONCLUSIONS Several limitations to the study may have precluded a finding of cost-effectiveness. Future studies should include prospective evaluation of costs and other outcomes in a comparison between acupuncture and usual care in a randomized control trial.
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Affiliation(s)
- Bijan J Borah
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, United States
| | - James M Naessens
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, United States
| | - Amy E Glasgow
- The Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
| | - Brent A Bauer
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Tony Y Chon
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, United States.
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García-Mochón L, Martín JJ, Aranda-Regules JM, Rivas-Ruiz F, Vas J. Cost effectiveness of using moxibustion to correct non-vertex presentation. Acupunct Med 2015; 33:136-41. [PMID: 25669428 DOI: 10.1136/acupmed-2014-010696] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
AIMS To analyse the cost effectiveness of using the moxibustion technique to correct non-vertex presentation and to reduce the number of caesarean sections performed at term. METHOD A deterministic model of decision analysis has been developed to analyse the cost of treatment in which heat is applied by moxibustion (the combustion of Artemisia vulgaris) at acupuncture point BL67 for pregnant women with non-vertex fetal position at 33-35 weeks' gestation. This approach was compared with conventional treatment recommendations based on the knee-chest posture technique. The costs were obtained mainly from data provided by the Andalusian Public Health System. Effectiveness data for the baseline analysis were taken from a previous clinical study. A secondary analysis was performed based on a meta-analysis conducted using random effects analysis, by reference to studies published in recent systematic reviews of moxibustion versus conventional treatment, in order to make the results generalisable to other healthcare settings. Deterministic and probabilistic sensitivity analyses were performed under diverse assumptions to assess the uncertainty of the result. RESULTS The baseline analysis shows that the application of moxibustion prevents 8.92% of deliveries with non-vertex presentation compared with conventional treatment, with an average cost saving of €107.11 per delivery, mainly due to the cost saving from avoiding the need for caesarean section. The meta-analysis revealed a relative risk of the version of non-vertex presentation at term of 0.34 (95% CI 0.16 to 0.76). The sensitivity analysis showed that moxibustion can avoid 0.34 caesarean sections, with an incremental cost per delivery ranging from €68 to -€640 for moxibustion versus conventional treatment. CONCLUSIONS Moxibustion treatment applied at acupuncture point BL67 can avoid the need for caesarean section and achieve cost savings for the healthcare system in comparison with conventional treatment.
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Affiliation(s)
| | - José J Martín
- Applied Economics Department, University of Granada, Granada, Spain
| | | | - Francisco Rivas-Ruiz
- Research Unit, Sanitary agency Costa del Sol, Marbella, Spain Carlos III Health Institute, Network of Research in Health Services in Chronic Diseases (REDISSEC), Madrid, Spain
| | - Jorge Vas
- Carlos III Health Institute, Network of Research in Health Services in Chronic Diseases (REDISSEC), Madrid, Spain Pain Treatment Unit, Doña Mercedes Primary Health Care Centre, Dos Hermanas, Spain
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Abstract
Healthcare in the United States is expensive and becoming more so every year. Policy and decision makers increasingly need information on costs, as well as effectiveness and safety, in order to formulate health-care strategies that are both clinically effective and financially responsible. Many people believe the benefits of complementary and integrative medicine (CIM) exceed its costs. Surveys have shown that a substantial portion of the US population uses CIM and pays directly for that use.1–4 The most recent estimates show that total US out-of-pocket expenditures for CIM were $34 billion—11% of all US out-of-pocket healthcare expenditures.1 However, if CIM is to be considered in broader healthcare strategies, its economic impact must be determined. Theoretically, CIM seems a good candidate for cost-effectiveness, and even cost savings, because it avoids high technology, offers inexpensive and noninvasive remedies, encourages healthy lifestyle change, and focuses on the whole person, all of which may improve health beyond the targeted disease or condition. However, to many in the conventional health-care system, CIM is seen only as an “add on” expense. What must be demonstrated via economic evaluation are the healthcare costs that can be avoided through the use of CIM. CIM offers the potential for several avenues of cost reduction. The first is as a direct replacement for the usual conventional therapy for a condition. The second is in terms of lower future healthcare utilization both in general (through treating the whole person) and for the targeted disease or condition. A third avenue to cost reduction is through reducing productivity loss for employers. A reduction in costs to employers does not directly reduce healthcare costs (unless the employer is itself a health-care facility); however, both are costs to society. Productivity losses can be reduced through improved employee health, and potentially through the improved employee well-being and empowerment offered by CIM.
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Affiliation(s)
- Patricia M Herman
- RAND Corporation, Santa Monica, California; Samueli Institute, Alexandria, Virginia
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Park JW, Lee BH, Lee H. Moxibustion in the management of irritable bowel syndrome: systematic review and meta-analysis. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 13:247. [PMID: 24088418 PMCID: PMC3851749 DOI: 10.1186/1472-6882-13-247] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 09/26/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder. Many patients suffer from IBS that can be difficult to treat, thus complementary therapies which may be effective and have a lower likelihood of adverse effects are being sought.This systematic review and meta-analysis aimed at critically evaluating the current evidence on moxibustion for improving global symptoms of IBS. METHODS We searched Medline, EMBASE, the Cochrane Central Register of Controlled Trials, AMED, CINAHL, and CNKI databases for randomised controlled trials (RCTs) of moxibustion comparing with sham moxibustion, pharmacological medications, and other active treatments in patients with IBS. Trials should report global symptom improvement as an outcome measure. Risk of bias for each RCT was assessed according to criteria by the Cochrane Collaboration, and the dichotomous data were pooled according to the control intervention to obtain a risk ratio (RR) of global symptom improvement after moxibustion, with 95% confidence intervals (CI). RESULTS A total of 20 RCTs were eligible for inclusion (n = 1625). The risk of bias was generally high. Compared with pharmacological medications, moxibustion significantly alleviated overall IBS symptoms but there was a moderate inconsistency among studies (7 RCTs, RR 1.33, 95% CI [1.15, 1.55], I² = 46%). Moxibustion combined with acupuncture was more effective than pharmacological therapy but a moderate inconsistency among studies was found (4 RCTs, RR 1.24, 95% CI [1.09, 1.41], I² = 36%). When moxibustion was added to pharmacological medications or herbal medicine, no additive benefit of moxibustion was shown compared with pharmacological medications or herbal medicine alone. One small sham-controlled trial found no difference between moxibustion and sham control in symptom severity (mean difference 0.35, 95% CI [-0.77, 1.47]). Moxibustion appears to be associated with few adverse events but the evidence is limited due to poor reporting. CONCLUSIONS This systematic review and meta-analysis suggests that moxibustion may provide benefit to IBS patients although the risk of bias in the included studies is relatively high. Future studies are necessary to confirm whether this finding is reproducible in carefully-designed and conducted trials and to firmly establish the place of moxibustion in current practice.
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Affiliation(s)
- Jae-Woo Park
- Gastroenterology Division, Department of Internal Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Korea
| | - Byung-Hee Lee
- Department of Medical Science of Meridian, Graduate School, Kyung Hee University, Seoul, Korea
| | - Hyangsook Lee
- Department of Medical Science of Meridian, Graduate School, Kyung Hee University, Seoul, Korea
- Acupuncture & Meridian Science Research Centre, College of Korean Medicine, Kyung Hee University, Seoul, Korea
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Vas J, Aranda-Regules JM, Modesto M, Ramos-Monserrat M, Barón M, Aguilar I, Benítez-Parejo N, Ramírez-Carmona C, Rivas-Ruiz F. Using moxibustion in primary healthcare to correct non-vertex presentation: a multicentre randomised controlled trial. Acupunct Med 2012; 31:31-8. [PMID: 23249535 DOI: 10.1136/acupmed-2012-010261] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To compare the effectiveness of additional moxibustion at point BL67 with moxibustion at a non-specific acupuncture point and with usual care alone to correct non-vertex presentation. METHODS This was a multicentre randomised controlled trial in which 406 low-risk pregnant women with a fetus in ultrasound breech presentation, with a gestational age of 33-35 weeks, were assigned to (1) true moxibustion at point BL67 plus usual care; (2) moxibustion at SP1, a non-specific acupuncture point (sham moxibustion) plus usual care; or (3) usual care alone. The primary outcome was cephalic presentation at birth. Women were recruited at health centres in primary healthcare. RESULTS In the true moxibustion group, 58.1% of the full-term presentations were cephalic compared with 43.4% in the sham moxibustion group (RR 1.34, 95% CI 1.05 to 1.70) and 44.8% of those in the usual care group (RR 1.29, 95% CI 1.02 to 1.64). The reduction in RR of the primary outcome in women allocated to the true moxibustion group compared with the usual care group was 29.7% (95% CI 3.1% to 55.2%) and the number needed to treat was 8 (95% CI 4 to 72). There were no severe adverse effects during the treatment. CONCLUSIONS Moxibustion at acupuncture point BL67 is effective and safe to correct non-vertex presentation when used between 33 and 35 weeks of gestation. We believe that moxibustion represents a treatment option that should be considered to achieve version of the non-vertex fetus. TRIAL REGISTRATION Current Controlled Trials ISRCTN10634508.
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Affiliation(s)
- Jorge Vas
- Pain Treatment Unit, Doña Mercedes Primary Health Care Centre, Andalusian Public Health System, Dos Hermanas, Sevilla 41700, Spain.
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Zhang Y, Zhao Y, Guo Y. Analysis of moxibustion reports published in journals of science citation index in recent 5 years. JOURNAL OF ACUPUNCTURE AND TUINA SCIENCE 2012. [DOI: 10.1007/s11726-012-0612-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
PURPOSE OF REVIEW Acupuncture has a growing clientele during pregnancy, delivery and the puerperium for an ever increasing list of indications. Objective evidence for its benefit is necessary to establish its roles in current practice. RECENT FINDINGS For many of the current uses, randomized studies when conducted using at least one control group have not established any clear advantages from treatment. Those areas which rely upon subjective assessment of symptoms are particularly difficult to investigate without rigorous blinding strategies, separating those who provide the acupuncture from those assessing outcome. Studies investigating the possible therapeutic benefit of acupuncture for managing intrapartum care require outcomes for nulliparae and multiparae to be analysed separately. SUMMARY Acupuncture therapy may offer some advantage over conventional treatment in the management of hyperemesis gravidarum and postcaesarean section pain and these areas warrant further study. Rigorous randomized studies, particularly those using objective measures, have failed to identify any obvious benefits from acupuncture for many of the other conditions studied.
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Herman PM, Poindexter BL, Witt CM, Eisenberg DM. Are complementary therapies and integrative care cost-effective? A systematic review of economic evaluations. BMJ Open 2012; 2:bmjopen-2012-001046. [PMID: 22945962 PMCID: PMC3437424 DOI: 10.1136/bmjopen-2012-001046] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE A comprehensive systematic review of economic evaluations of complementary and integrative medicine (CIM) to establish the value of these therapies to health reform efforts. DATA SOURCES PubMed, CINAHL, AMED, PsychInfo, Web of Science and EMBASE were searched from inception through 2010. In addition, bibliographies of found articles and reviews were searched, and key researchers were contacted. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies of CIM were identified using criteria based on those of the Cochrane complementary and alternative medicine group. All studies of CIM reporting economic outcomes were included. STUDY APPRAISAL METHODS: All recent (and likely most cost-relevant) full economic evaluations published 2001-2010 were subjected to several measures of quality. Detailed results of higher-quality studies are reported. RESULTS A total of 338 economic evaluations of CIM were identified, of which 204, covering a wide variety of CIM for different populations, were published 2001-2010. A total of 114 of these were full economic evaluations. And 90% of these articles covered studies of single CIM therapies and only one compared usual care to usual care plus access to multiple licensed CIM practitioners. Of the recent full evaluations, 31 (27%) met five study-quality criteria, and 22 of these also met the minimum criterion for study transferability ('generalisability'). Of the 56 comparisons made in the higher-quality studies, 16 (29%) show a health improvement with cost savings for the CIM therapy versus usual care. Study quality of the cost-utility analyses (CUAs) of CIM was generally comparable to that seen in CUAs across all medicine according to several measures, and the quality of the cost-saving studies was slightly, but not significantly, lower than those showing cost increases (85% vs 88%, p=0.460). CONCLUSIONS This comprehensive review identified many CIM economic evaluations missed by previous reviews and emerging evidence of cost-effectiveness and possible cost savings in at least a few clinical populations. Recommendations are made for future studies.
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Affiliation(s)
- Patricia M Herman
- Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy, University of Arizona, Tucson, Arizona, USA
| | - Beth L Poindexter
- Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Claudia M Witt
- Institute for Social Medicine, Epidemiology and Health Economics, Charite’ University Medical Center, Berlin, Germany
- Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - David M Eisenberg
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Harvard School of Public Health, Boston, Massachusetts, USA
- Samueli Institute, Alexandria, Virginia, USA
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Health economic evaluation in complementary medicine. Complement Ther Med 2011; 19:289-302. [DOI: 10.1016/j.ctim.2011.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2010] [Revised: 08/12/2011] [Accepted: 09/12/2011] [Indexed: 12/18/2022] Open
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