Nice Guideline on Osteoarthritis: Is it Fair to Acupuncture? Yes

Latimer, Nicholas

doi:10.1136/aim.2009.000802

Cited by 13 publications

(7 citation statements)

References 14 publications

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“…This is one reason why acupuncture has received some attention in the UK [7,4,10,5]. Despite providing a lengthy introduction, the authors fail to cite academic literature that does not support CAM.…”

Section: Reporting Issuesmentioning

confidence: 99%

Do patients registered with CAM-trained GPs really use fewer health care resources and live longer? A response to Kooreman and Baars. Eur J Health Econ (2012). 13:469–776

2013

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Section: Reporting Issuesmentioning

confidence: 99%

Do patients registered with CAM-trained GPs really use fewer health care resources and live longer? A response to Kooreman and Baars. Eur J Health Econ (2012). 13:469–776

2013

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“…Also, another recent metaanalysis of acupuncture for OA of the knee shows that there is a clinically irrelevant short-term and long-term improvement in pain and function compared with a sham control. 4 This underlines the issue raised in the guideline concerning heterogeneity of acupuncture trial outcomes.…”

Section: The Long-term Effectiveness Of Acupuncturementioning

confidence: 99%

“…This paper discusses three of the NICE conclusions that could be open to different interpretations, and a response is published in the accompanying paper. 4 …”

mentioning

confidence: 99%

Nice Guideline on Osteoarthritis: Is it Fair to Acupuncture? No

White¹

2009

Acupunct Med

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A new guideline on the care and management of osteoarthritis has recently been published by the National Institute for Health and Clinical Excellence, and makes wide-ranging and authoritative recommendations. The guideline states that there is insufficient evidence to recommend acupuncture. There appears to be three areas where the guidelines may have not used the available evidence in the most appropriate manner. First, data on the long-term effectiveness of acupuncture may have been misinterpreted. Second, the specific rejection of electroacupuncture indicates a restricted understanding of acupuncture as a treatment, and is based on a cost-effectiveness analysis which may not be ideal. Third, the cost-effectiveness calculations used comparisons with sham acupuncture (“placebo”) when comparison with standard care would have been more appropriate. The guideline may therefore lead some patients with osteoarthritis to miss out on a treatment that may be effective for them.

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“…[1][2][3] The NICE OA guideline, issued in February 2008, recommended against the use of electroacupuncture and also concluded that existing evidence was not of suffi cient consistency or strength to recommend the use of acupuncture. 4 Conversely, the NICE guidance for LBP, issued in May 2009, recommended that clinicians should consider offering a course of acupuncture therapy comprising a maximum of 10 sessions over a period of up to 12 weeks.…”

Section: Introductionmentioning

confidence: 99%

“…The approach adopted in the guideline was considered to represent a suitable commonality for all analyses, rather than using a 'no treatment' or 'usual care with no placebo' comparator for the analysis of some interventions, and a placebo comparator for others. 3 In the LBP guideline, one relevant economic evaluation was identifi ed, which examined the cost-effectiveness of acupuncture delivered by therapists trained in traditional Chinese medicine. 7 The study found that acupuncture was associated with base case cost-effectiveness estimates (£4241 per quality adjusted life year (QALY) gained) that are acceptable to NICE; Inconsistencies in NICE guidance for acupuncture: reanalysis and discussion Original paper accordingly, acupuncture therapy was recommended by the guideline.…”

Section: Introductionmentioning

confidence: 99%

Inconsistencies in Nice Guidance for Acupuncture: Reanalysis and Discussion

Latimer

Bhanu²,

Whitehurst

2012

Acupunct Med

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Background Acupuncture received a positive recommendation in the National Institute for Health and Clinical Excellence (NICE) clinical guideline for low back pain (LBP). However, no such recommendation was forthcoming in the NICE clinical guideline for osteoarthritis (OA). Importantly, the two guidelines adopted different treatment comparators in their economic analyses of acupuncture; in the LBP guideline ‘usual care’ was used (with no consideration of placebo/sham interventions), whereas ‘sham acupuncture’ was the comparator in the OA guideline. Objective To analyse the implications of using different control group comparators when estimating the cost-effectiveness of acupuncture therapy. Methods The NICE OA economic analysis for acupuncture was replicated using ‘usual care’ (ie, no placebo/sham component) as the treatment comparator. A ‘transfer-to-utility’ technique was used to transform Western Ontario and McMaster Osteoarthritis scores into EQ-5D utility scores to allow quality-adjusted life year (QALY) gains to be estimated. QALY estimates were combined with direct incremental cost estimates of acupuncture treatment to determine incremental cost-effectiveness ratios (ICERs). Results When ‘usual care’ was used as the treatment comparator, ICER point estimates were below £20 000 per QALY gained for each acupuncture trial analysed in the OA clinical guideline. In the original analysis, using placebo/sham acupuncture as the treatment comparator, ICERs were generally above £20 000 per QALY gained. Conclusion The treatment comparator chosen in economic evaluations of acupuncture therapy is likely to be a strong determinant of the cost-effectiveness results. Different comparators used in the OA and LBP NICE guidelines may have led to the divergent recommendations in the guidelines.

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Nice Guideline on Osteoarthritis: Is it Fair to Acupuncture? Yes

Cited by 13 publications

References 14 publications

Do patients registered with CAM-trained GPs really use fewer health care resources and live longer? A response to Kooreman and Baars. Eur J Health Econ (2012). 13:469–776

Do patients registered with CAM-trained GPs really use fewer health care resources and live longer? A response to Kooreman and Baars. Eur J Health Econ (2012). 13:469–776

Nice Guideline on Osteoarthritis: Is it Fair to Acupuncture? No

Inconsistencies in Nice Guidance for Acupuncture: Reanalysis and Discussion

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