Clinical Effect And Health Economic Evaluation On Three Electro-acupuncture Therapies For Patients With Sciatica Due To Lumbar Disk Herniation

Objective:To determine the most optimal electro-acupuncture therapy for patients with sciatica due to lumbar disc herniation (LDH) by Cost-Effectiveness Analysis (CEA) and Cost-Utility Analysis (CUA).Methods:1. Clinical:Allocated324patients with sciatica due to LDH into three groups: electro-acupuncture group (Group A), electro-acupuncture+traction group (Group B), electro-acupuncture+traction+drugs group (Group C) randomized centrally. Treatment course was six weeks. Evaluated the clinical effect in each week and follow-up time by Short-Form McGill Pain Questionnaire (SF-MPQ) and Modified Roland-Morris Disability Questionnaire (MRDQ).2. Health economic evaluation:Compared the SF-MPQ and MRDQ results with cost to acquire the Cost-Effectiveness Ratio (CER). Selected SF-36-based British SF-6D for utility calculating in order to compute QALYs. Then compared QALY with cost to obtain CUR and ICUR. Conducted the sensitivity analysis to prove the reliability.Results:1. Results of therapeutic evaluation:Basicline was consistent. After six weeks treatment, the SF-MPQ, MRDQ scores of324patients treated by three therapies were all decreased significantly(P<0.01) and associated with time effect. The points of SF-MPQ decreased51.5±21.2,55.6±25.2,54.1±23.7, as well as MRDQ points decreased9.1±5.0,9.8±4.7,8.3±4.7. But scores among three groups on different time had no significant difference (P>0.05).2. Results of Health economic evaluation:(1) Total Cost:At the end of the trial, the total cost of group A, B and C were￥1867.3, ￥2204.4and￥2242.4respectively, which had significant difference (P<0.01). As the condition of therapeutic evaluation results showed no difference between three groups, cost-minimization analysis (CMA) could be applied in health economic evaluation. Group A is lowest by CMA.(2) Cost-effectiveness Analysis:At the end of the trial, cost decrease for three electro-acupuncture groups were￥37.55,￥42.91,￥42.97when SF-MPQ decreased1porint. Reduction of CER for MRDQ of three electro-acupuncture groups were￥212.52/point,￥243.43/point and￥280.1/point. These results demonstrated that group A is the lowest by CEA.(3) Cost-utility analysis:The cost-utility ratio (CUR) of the group A,B and C were￥23831.55/QALY,￥28870.99/QALY and￥28379.27/QALY, group A was the lowest of the three. Compared with the group A, the incremental cost-utility ratios (ICUR) of the other two groups were￥305189.19/QALY,￥507662.34/QALY, exceed the societal threshold (￥38354). Sensitivity analysis supported the results.Conclusion:1. Electro-acupuncture, electro-acupuncture+traction and electro-acupuncture+traction+drugs therapies have the same efficacy on improving pain and function of patients with sciatica due to LDH.2. The total cost of the electro-acupuncture therapy is lower than the combination therapies, as well as CEA and CUA of the electro-acupuncture therapy is more optimal.