| ObjectiveThe efficacy of multiple acupuncture therapies for the treatment of allergic rhinitis was compared by reticulated Meta-analysis to derive a ranking of therapeutic superiority.The results of the reticulated Meta-analysis were used to evaluate the health economics of the included interventions and to obtain the interventions with good efficacy and affordability.A questionnaire was used to understand the attitudes and intentions of patients with allergic rhinitis not treated with acupuncture therapy toward acupuncture,and to analyze the factors and mechanisms of action affecting the intentions.The results of these studies were synthesized to provide a reference for clinical practice and decision making.Methods1.Network Meta-analysis:Chinese and English subject words and free words search for Chinese and English subject words such as "rhinitis,allergic,allergic rhinitis,acupuncture therapy,acupuncture point insertion,acupuncture point injection,etc.Wan Fang,Vip Journal Resource Database(VIP),PubMed,Embase,Cochrane Library and other databases have been related to literature for nearly two decades.Studies were selected according to exclusion criteria,information was extracted for inclusion,and study quality was assessed using the Cochrane Risk of Bias Assessment.The outcome measures were short-term effective rate.long-term effective rate,RQLQ,and IgE,of which short-term effective rate was divided into short course(treatment course of 1-2 weeks),medium course(duration of treatment of 3-5 weeks),and long course(treatment course of 6-12 weeks)according to the length of treatment.The network meta-analysis under the Bayesian framework mainly relies on ADDIS 1.16.6 and R 4.2.2,using ADDIS software to complete the convergence degree of the consistency test model,draw the league map,use R software "gemtc" to test heterogeneity,draw a forest map and probability ranking map of intervention and western medicine,and output the area under the cumulative probability map(SUCRA)value.Both software used the Markov Chain Monte Carlo(MCMC)random-effects model,with 4 chains for simulation,the initial value was set to 2.5,the step size was 10,the number of iterations was set to the first 20,000 times for annealing,and the last 50,000 or 100,000 times for sampling;the dichotomous variables(short-term effective and long-term effective)were expressed by odds ratio(OR),which was 95%The confidence interval crossing 1 indicated that the difference between the two was not statistically significant,the continuous variables(RQLQ,IgE)were expressed by mean difference(MD)and both were expressed by effect values and their 95%confidence interval(CI),and the 95%confidence interval crossed 0 indicating that the difference was not statistically significant.The network meta-analysis under the frequentology framework is mainly implemented by the "network" group command of the Stata 15.1 software,and the content is as follows:(1)inconsistency test(global inconsistency test,closed loop inconsistency test,local inconsistency test),(2)the recent effective rate is plotted with OR and RD as the effect value,respectively,where OR is used to compare with the recent efficient network analysis results under the Bayesian framework to determine the stability of the results of the two frameworks.At the same time,it is used as an indicator of sensitivity analysis.RD w ill be used in the calculation of incremental outcome-effect ratios in health economics evaluations.(3)SUCRA was calculated for each intervention and compared with this result calculated using a Bayesian model.Output a cumulative probability ranking plot.The final ranking of the efficacy of each intervention was determined by calculating the mean of the outcomes SUCRA under the Bayesian framework.2.Health Economics Evaluation:The same literature included in the health economics review as in the network meta-analysis.Estimate direct and indirect costs article by article.Direct costs include acupuncture treatment fees(including the use of drugs),Western medicines,Chinese medicines,etc.,and indirect costs include lost work and miscarriage and transportation expenses.The results of the recent effective network meta-analysis(effect size RD)in the framework of frequency were used as health outcomes,using the same grouping as in the network meta-analysis,that is,according to the length of treatment,it was divided into short-course group,medium-course group and long-course group.The indicators of this health economics evaluation are incremental cost-effectiveness ratio(ICER)and minimal cost analysis(CMA).For two interventions with significant differences in efficacy,the incremental cost-effectiveness ratio was calculated,with the RD value as the difference in health outcomes.For interventions with no significant difference in efficacy,the size was compared after calculating the total cost using a minimum cost analysis.Finally,the average of ICER rankings and CMA rankings of each intervention at each group level was calculated to estimate the economic ranking of each intervention.3.Questionnaire survey:Design a questionnaire according to the purpose of the survey,and conduct an on-site survey of allergic rhinitis patients(who have not used acupuncture therapy for allergic rhinitis)who are treated in the outpatient clinic of the otolaryngology department of the Chinese medicine hospital with the help of the Wenjuanxing platform,and conduct a formal investigation after two pre-investigations.Survey data are imported into SPSS 28 software for descriptive statistical analysis of ordinal variables and scale data.In the empirical research part,the reliability and validity of the self-designed scale are first tested.Confirmatory factor analysis in validity tests is done using Amos 24 software.The SPSS software Process program(compiled by Hayes)Bootstrap method(repeated sampling 5000 times)was used to test whether the hypothetical mediation effect model and chain mediation effect model were valid.Results1.Network Meta-analysis:A total of 7083 articles were identified in the search,128 of which were included after screening,all of which were randomized controlled trials,and the risk factors for bias were mainly concentrated in blinding,blinding of physicians and patients,all of which were at high risk,and only 5 of the reviewers were blinded.A total of 11,563 patients with allergic rhinitis were included in the included literature.It involves 21 kinds of interventions,acupuncture,moxibustion,acupoint application,acupoint injection,acupoint thread burial,ear point bean pressing,electroacupuncture,western medicine,traditional Chinese medicine,acupuncture+moxibustion,acupuncture+acupoint application,acupuncture+acupoint injection,acupuncture+electroacupuncture,acupuncture+warm acupuncture,acupuncture+western medicine,acupuncture+traditional Chinese medicine,moxibustion+western medicine,acupoint application+Chinese medicine,acupoint application+western medicine,acupuncture+Chinese medicine+western medicine,moxibustion+traditional Chinese medicine+western medicine.Under the Bayesian framework,there were statistical differences compared with Western drugs,and the intervention indicators were:(1)short course of short course with short response rate,acupuncture,acupuncture+Western medicine,moxibustion.(2)The medium course of treatment is effective in the near future,acupuncture,moxibustion,acupoint injection,electroacupuncture,acupuncture+moxibustion,acupuncture+acupoint application,acupuncture+acupoint injection,acupuncture+electroacupuncture,acupuncture+warm acupuncture,acupuncture+western medicine,acupuncture+traditional Chinese medicine,moxibustion+western medicine,acupoint application+Chinese medicine,acupoint application+western medicine,acupuncture+western medicine,acupuncture+traditional Chinese medicine+western medicine,moxibustion+traditional Chinese medicine+western medicine.(3)Long-term treatment course has a recent effective rate,none.(4)Long-term effective rate,acupuncture,acupuncture+moxibustion,acupuncture+electroacupuncture,acupuncture+warm acupuncture,acupuncture+traditional Chinese medicine,moxibustion,acupoint application,acupoint application+western medicine,acupoint application+traditional Chinese medicine,acupoint injection,acupoint thread burial,Chinese medicine.(5)RQLQ,acupuncture,acupuncture+moxibustion,acupuncture+warm acupuncture,acupuncture+western medicine,acupuncture+traditional Chinese medicine,acupoint application+western medicine.(6)IgE,acupuncture+warm acupuncture,acupuncture+western medicine,moxibustion+traditional Chinese medicine+western medicine.The network analysis results calculated by applying Bayesian model are similar to those calculated by applying frequentological methods:(1)The OR value and its confidence interval are not much different,and the comparison with significant differences is not changed.(2)The SUCRA values of the interventions under the corresponding outcome indicators were similar in the two models,and the ranking was basically the same.The mean ranking of SUCRA rankings for each intervention under each outcome was exactly the same in both models,and the ranking was acupuncture+western medicine>acupuncture+traditional Chinese medicine>acupuncture+acupoint injection>moxibustion method+traditional Chinese medicine+western medicine>acupoint application+Chinese medicine>acupuncture+moxibustion>acupuncture+traditional Chinese medicine+western medicine>acupuncture+electroacupuncture>acupuncture+warm acupuncture>acupoint application+western medicine>moxibustion method+western medicine>acupoint injection>moxibustion method>acupoint thread burial>acupuncture+acupoint application>acupuncture>electroacupuncture>traditional Chinese medicine>acupoint application>western medicine>ear point pressure bean.According to the comparison results,the results calculated in different models are basically the same,which can be used as the basis for sensitivity analysis.and the results are considered to be stable.At the same time,it also shows that the results of the frequentist model are basically the same as the results of the Bayesian model,and the results obtained under the frequentism model can be used in the evaluation of health economics.2.Health Economics Evaluation:(1)Short-course group:ICER was controlled by Western medicine.and those with low ICER had high economy,ranking acupuncture+Western medicine,acupuncture+Chinese medicine,moxibustion,acupuncture;CM A ranking is acupuncture + western medicine,acupoint application+western medicine,moxibustion,acupuncture+traditional Chinese medicine,acupuncture+moxibustion;(2)Medium course of treatment:ICER takes western medicine,ear point pressure bean,acupoint application,traditional Chinese medicine,moxibustion,acupuncture as reference,and the comprehensive ranking of each intervention is acupoint application+western medicine,acupuncture+acupoint injection,acupoint injection,moxibustion + western medicine,acupuncture+acupoint application,acupuncture+western medicine,electroacupuncture,acupoint application+traditional Chinese medicine,acupuncture+electroacupuncture,acupuncture+moxibustion,acupuncture+traditional Chinese medicine,acupuncture+Chinese medicine+western medicine,acupuncture,acupuncture+warm acupuncture,moxibustion,moxibustion+traditional Chinese medicine+western medicine.CMA ranking is acupoint application+western medicine,acupoint injection,acupoint thread embedding,acupuncture+western medicine,acupuncture+electroacupuncture,moxibustion+western medicine,acupuncture+acupoint injection,electroacupuncture,acupuncture+acupoint application,acupoint application+Chinese medicine,acupuncture+moxibustion,acupuncture+warm acupuncture,acupuncture+Chinese medicine+western medicine,acupuncture+traditional Chinese medicine.moxibustion+traditional Chinese medicine+western medicine.(3)Long-course group:CMA ranked as western medicine,acupoint injection,acupoint thread burial,and acupuncture.The rankings of ICER and CMA in each group were acupoint application+western medicine,acupoint injection,acupuncture+western medicine,acupoint thread burial,acupuncture+acupoint injection,moxibustion+western medicine,acupuncture.acupuncture+acupuncture,acupuncture+acupuncture,acupuncture + electroacupuncture,moxibustion,electroacupuncture,acupuncture+traditional Chinese medicine,acupuncture+moxibustion.acupuncture+Chinese medicine,acupuncture+Chinese medicine+western medicine,acupuncture+warm acupuncture,moxibustion+traditional Chinese medicine+western medicine.3.Questionnaire survey:263 valid questionnaires were collected,and the respondents were all patients who had not received acupuncture therapy for allergic rhinitis in the Department of Otorhinolaryngology of Traditional Chinese Medicine Hospital,and the sex ratio was even.The average willingness of patients to receive acupuncture therapy overall was 6.44(options from 0-10),which can be understood as more than 60%probability of receiving acupuncture therapy in the future.The correlation analysis between willingness and demographic variables in the questionnaire showed that the patient’s education level,time of illness,medical payment method,and whether there were allergic diseases were associated with the willingness to receive acupuncture therapy.Assuming that the willingness is related to the patient’s awareness of acupuncture,the severity of the disease and the acceptance of the actual problems of acupuncture,empirical studies show that(1)The general cognition of acupuncture can significantly positively predict the acceptance of actual problems,and the cognition of safety and effectiveness play a part of the chain mediating effect.(2)The degree of acupuncture awareness can significantly predict the willingness of acupuncture in a positive direction,and the acceptance of actual problems plays a part of the mediating effect.(3)Disease severity can significantly predict acupuncture intention,and actual problem acceptance plays a part-mediating role.In addition,under the conditions of "specialist advice,family and friend recommendation,other patient recommendation,poor drug efficacy,and repeated illness",patients are willing to try acupuncture therapy,among which "specialist advice" causes the strongest will.According to the survey,most patients receive a single acupuncture treatment fee of 50 yuan to 100 yuan,and are able or willing to receive acupuncture treatment 1-2 times a week.There is confidence in completing the 4-week,3weekly treatment,but not much.Patients preferred non-invasive acupuncture but were more receptive to acupuncture/electroacupuncture than other invasive acupuncture therapies.Most patients expect the treatment methods of acupuncture+Chinese medicine and acupuncture+Chinese medicine+Western medicine,and focus on long-term efficacy.Conclusion1.The top five ranked interventions in terms of efficacy after combining multiple outcome indicators in the reticulated Meta-analysis were acupuncture+Western medicine,acupuncture+Chinese medicine,acupuncture+acupoint injection,moxibustion+Chinese medicine+Western medicine,and acupoint application+Chinese medicine.2.The top five interventions ranked by health economics evaluation in terms of economy were acupuncture+western medicine,acupoint injection,acupuncture+western medicine,acupoint burial,and acupuncture+acupoint injection.3.Both acupuncture+western medicine and acupuncture+acupoint injection were ranked in the top five in the reticulated Meta-analysis and health economics evaluation.indicating that the conclusion that both interventions are effective and economical is more reliable.4.In the questionnaire study,patients with allergic rhinitis had the intention to use acupuncture therapy.Willingness was influenced by demographic variables such as literacy,medical payment method,duration of illness,and whether other allergic diseases were comorbid,in addition to patient awareness of acupuncture,acceptance of practical problems with acupuncture therapy,and severity of illness.Using a(chained)mediated effects model,it was ultimately concluded that increasing perceptions of safety and effectiveness were key factors in increasing patient willingness.According to the survey,patients were more likely to accept the advice of a specialist and choose acupuncture therapy,possibly because the specialist was able to provide patients with the most reliable and credible evidence of the safety and efficacy of acupuncture therapy compared to other sources of access.5.Relationships among the three studies:patient willingness surveys yielded key factors for increasing patient willingness to acupuncture as safety and efficacy perceptions,and reticulated Meta-analysis provided evidence of the efficacy and safety of acupuncture therapies that can be used as a basis for increasing patient perceptions of the efficacy and safety of acupuncture.The health economics evaluation selected efficacious and costeffective interventions that are worthwhile for clinical acupuncturists to learn from in order to increase patient acceptance of the actual problem of acupuncture and thus increase willingness to use acupuncture.The combination of the patient willingness survey study and the two studies on the efficacy,safety,and economics of acupuncture therapy makes this study more comprehensive in its overall clinical practical significance. |
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