An economic evaluation of Alexander Technique lessons or acupuncture sessions for patients with chronic neck pain: A randomized trial (ATLAS)

Abstract

ObjectivesTo assess the cost-effectiveness of acupuncture and usual care, and Alexander Technique lessons and usual care, compared with usual GP care alone for chronic neck pain patients.MethodsAn economic evaluation was undertaken alongside the ATLAS trial, taking both NHS and wider societal viewpoints. Participants were offered up to twelve acupuncture sessions or twenty Alexander lessons (equivalent overall contact time). Costs were in pounds sterling. Effectiveness was measured using the generic EQ-5D to calculate quality adjusted life years (QALYs), as well as using a specific neck pain measure–the Northwick Park Neck Pain Questionnaire (NPQ).ResultsIn the base case analysis, incremental QALY gains were 0.032 and 0.025 in the acupuncture and Alexander groups, respectively, in comparison to usual GP care, indicating moderate health benefits for both interventions. Incremental costs were £451 for acupuncture and £667 for Alexander, mainly driven by intervention costs. Acupuncture was likely to be cost-effective (ICER = £18,767/QALY bootstrapped 95% CI £4,426 to £74,562) and was robust to most sensitivity analyses. Alexander lessons were not cost-effective at the lower NICE threshold of £20,000/QALY (£25,101/QALY bootstrapped 95% CI -£150,208 to £248,697) but may be at £30,000/QALY, however, there was considerable statistical uncertainty in all tested scenarios.ConclusionsIn comparison with usual care, acupuncture is likely to be cost-effective for chronic neck pain, whereas, largely due to higher intervention costs, Alexander lessons are unlikely to be cost-effective. However, there were high levels of missing data and further research is needed to assess the long-term cost-effectiveness of these interventions.

Visceral Origin: An Underestimated Source of Neck Pain. A Systematic Scoping Review

“…The assessment of the methodological quality by means of the PEDro scale revealed that, in general, the top 15 most cited clinical trials denoted adequate to good methodological quality, with a final score of six points or higher, except for one study that scored five out of 10 points (Table 1) [36]. Similar findings were observed amongst the 15 most recent articles published in high impact journals (Table 2), although one study denoted poor methodological quality (four out of 10) [37]. One of all studies included achieved excellent methodological quality (10 out of 10) [38].…”

“…Some other visceral sources of NP were enumerated in other clinical trials: (a) hepatitis [37]; (b) systemic disorders, including metabolic disease [30,35,36,41,46,57,58]; (c) abuse of alcohol and drugs [37,54]; (d) rheumatic disease [31][32][33]35,37,46,49,[51][52][53]55,56,58]; (e) cancer [30,31,35,37,42,[51][52][53][55][56][57]; (f) HIV [37]; and (g) infection [30,33,34,40,45,47,57]. Pregnancy was also included as exclusion criteria in almost half of the trials [30,32,34,37,38,40,…”

Costing Methodology and Key Drivers of Health Care Costs Within Economic Analyses in Musculoskeletal Community and Primary Care Services: A Systematic Review of the Literature

“…The majority of studies reported the year cost data were collected (Q10), with only 3 studies omitting this level of detail. 19,30,32 The base cost year was also reported for most studies (Q11) with this information not present in only 1 study. 32 Adjustments for costs made in different time periods (Q12) were frequently not necessary due to the majority of studies being run over a 12 month period and therefore not needing to discount for different time periods, with the exception of Barton et al 33 who discounted at a rate of 3.5%.…”

Moving With Pain: What Principles From Somatic Practices Can Offer to People Living With Chronic Pain

“…To date, a set of somatic principles for supporting chronic pain management across a range of conditions has not been theorized or tested, while open structured approaches have been underexplored, and interdisciplinary research on the topic is lacking. 1 There is some research on structured forms such the Alexander Technique (e.g., Essex et al, 2017 ; Woodman et al, 2018 ) and Feldenkrais Method ( Ahmadi et al, 2020 ), while lay books on Hanna somatics for pain exist ( Peterson, 2012 ; St. Pierre, 2015 ). Open somatic frameworks that “rely on more autonomy in movement response lying with the client” ( Weber, 2009 , p. 239) with improvisatory, non-stylized guided sessions (such as Authentic Movement) are missing from research on chronic pain.…”