Health economic evaluation in complementary medicine

Overview and quality assessment of health economic evaluations for homeopathic therapy: an updated systematic review

INTRODUCTION

Likewise other medical interventions, economic evaluations of homeopathy contribute to the evidence base of therapeutic concepts and are needed for socioeconomic decision-making. A 2013 review was updated and extended to gain a current overview.

METHODS

A systematic literature search of the terms 'cost' and 'homeopathy' from January 2012 to July 2022 was performed in electronic databases. Two independent reviewers checked records, extracted data, and assessed study quality using the Consensus on Health Economic Criteria (CHEC) list.

RESULTS

Six studies were added to 15 from the previous review. Synthesizing both health outcomes and costs showed homeopathic treatment being at least equally effective for less or similar costs than control in 14 of 21 studies. Three found improved outcomes at higher costs, two of which showed cost-effectiveness for homeopathy by incremental analysis. One found similar results and three similar outcomes at higher costs for homeopathy. CHEC values ranged between two and 16, with studies before 2009 having lower values (Mean ± SD: 6.7 ± 3.4) than newer studies (9.4 ± 4.3).

CONCLUSION

Although results of the CHEC assessment show a positive chronological development, the favorable cost-effectiveness of homeopathic treatments seen in a small number of high-quality studies is undercut by too many examples of methodologically poor research.

Comparative cost analysis of inpatient integrative medicine-Results of a pilot study

BACKGROUND

Costs of integrative treatment alone and in comparison with other treatment approaches have scarcely been reported in the past. This study presents results of a comparative cost analysis of an inpatient integrative medicine treatment costs.

METHODS

Data from 2006 for inpatients referred to a Department of Integrative Medicine in Germany were used. Case-related treatment costs were calculated, and transformed into Casemix-Indices and revenues per DRG. Costs were compared between departments at the same hospital and between different hospitals using univariate statistics and Chi-Square tests.

RESULTS

In total 1253 inpatients (81.4% female, 61.1±14.4years) were included in the current analysis. Most patients were treated for diseases of the musculoskeletal system (57.2%), followed by diseases of the digestive system (11.4%), and diseases of the nervous system (10.4%). The department received an additional payment for most of the patients (88.0%), which led to an effective appreciation of 10.8% per case compared to the standardized Casemix-Index. In-house comparisons with other departments found the department in close vicinity to the departments of Internal medicine with regards to CMI and mean revenue, however the Patient Clinical Complexity Level was significantly lower in the Integrative medicine department. The interhospital comparison revealed comparable Casemix-Index and DRG-revenue, however the additional payment increased the mean revenue significantly.

CONCLUSION

Modern integrative in-patient treatment is mostly cost-equivalent to conventional treatment. Cost effectiveness studies should be considered to further investigate the potential of integrative in patient treatment.

Ethical implications of the increasing use of complementary and alternative medicine

BACKGROUND

The increasing demand for complementary and alternative medicine (CAM) raises ethical questions about specific aspects of both CAM and conventional medicine (COM).

METHODS

The present article provides a critical survey of the most important ethical aspects in the current debate about CAM.

RESULTS

The relevant ethical issues arise mainly in 4 main areas: 1) patient information, 2) research ethics, 3) cost, and 4) education. Most of the contributions used for our purpose are based upon the implicit assumption that, in principle, the ethics of CAM and COM have to be identical because of the same underlying doctor-patient relationship. This premise is shared by the author.

CONCLUSIONS

Substantial efforts on various levels will have to be made in order to create the conditions necessary for CAM to be ethically justified. But the ethical implications for COM also have to be considered.