Systematic review of the long-term effects and economic consequences of treatments for obesity and implications for health improvement

Alison Avenell, J. Broom, Tamara Joanne Brown, Amudha Sujatha Poobalan, Lorna Sharman Aucott, S. C. Stearns, William Cairns Stewart Smith, R. T. Jung, Marion Kay Campbell, Adrian Maxwell Grant

Research output: Contribution to journalArticle

488 Citations (Scopus)

Abstract

Objectives: To determine the effects of a policy of using acupuncture, compared with a policy of avoiding acupuncture, on headache in primary care patients with chronic headache disorders. The effects of acupuncture on medication use, quality of life, resource use and days off sick in this population and the cost-effectiveness of acupuncture were also examined.

Design: Randomised, controlled trial.

Setting: General practices in England and Wales.

Participants: The study included 401 patients with chronic headache disorder, predominantly migraine.

Interventions: Patients were randomly allocated to receive up to 12 acupuncture treatments over 3 months or to a control intervention offering usual care.

Main outcome measures: Outcome measures included headache score; assessment of Short Form 36 (SF-36) health status and use of medication at baseline, 3 months and 12 months; assessment of use of resources every 3 months; and assessment of incremental cost per quality-adjusted life-year ( QALY) gained.

Results: Headache score at 12 months, the primary end-point, was lower in the acupuncture group than in controls. The adjusted difference between means was 4.6. This result was robust to sensitivity analysis incorporating imputation for missing data. Patients in the acupuncture group experienced the equivalent of 22 fewer days of headache per year. SF-36 data favoured acupuncture, although differences reached significance only for physical role functioning, energy and change in health. Compared with controls, patients randomised to acupuncture used 15% less medication, made 25% fewer visits to GPs and took 15% fewer days off sick. Total costs during the 1-year period of the study were on average higher for the acupuncture group than for controls because of the acupuncture practitioners' costs. The mean health gain from acupuncture during the year of the trial was 0.021 QALYs, leading to a base-case estimate of pound9180 per QALY gained. This result was robust to sensitivity analysis. Cost per QALY dropped substantially when the analysis incorporated likely QALY differences for the years after the trial.

Conclusions: The study suggests that acupuncture leads to persisting, clinically relevant benefits for primary care patients with chronic headache, particularly migraine. It is relatively cost-effective compared with a number of other interventions provided by the NHS. Further studies could examine the duration of acupuncture effects beyond 1 year and the relative benefit to patients with migraine with compared to tension-type headache. Trials are also warranted examining the effectiveness and cost-effectiveness of acupuncture in patients with headache receiving more aggressive pharmacological management.

Original languageEnglish
Pages (from-to)1-182
Number of pages181
JournalHealth Technology Assessment
Volume8
Issue number21
Publication statusPublished - May 2004

Keywords

  • LOW-BACK-PAIN
  • TENSION-TYPE HEADACHE
  • CHRONIC NECK PAIN
  • CHINESE MEDICINE ACUPUNCTURISTS
  • CLINICAL-TRIAL
  • DOUBLE-BLIND
  • NEEDLE ACUPUNCTURE
  • COMPLEMENTARY MEDICINE
  • PROPHYLACTIC TREATMENT
  • POSTOPERATIVE PAIN

Cite this

Systematic review of the long-term effects and economic consequences of treatments for obesity and implications for health improvement. / Avenell, Alison; Broom, J.; Brown, Tamara Joanne; Poobalan, Amudha Sujatha; Aucott, Lorna Sharman; Stearns, S. C.; Smith, William Cairns Stewart; Jung, R. T.; Campbell, Marion Kay; Grant, Adrian Maxwell.

In: Health Technology Assessment, Vol. 8, No. 21, 05.2004, p. 1-182.

Research output: Contribution to journalArticle

@article{990d09be36044940b9758d52acdcab9a,
title = "Systematic review of the long-term effects and economic consequences of treatments for obesity and implications for health improvement",
abstract = "Objectives: To determine the effects of a policy of using acupuncture, compared with a policy of avoiding acupuncture, on headache in primary care patients with chronic headache disorders. The effects of acupuncture on medication use, quality of life, resource use and days off sick in this population and the cost-effectiveness of acupuncture were also examined.Design: Randomised, controlled trial.Setting: General practices in England and Wales.Participants: The study included 401 patients with chronic headache disorder, predominantly migraine.Interventions: Patients were randomly allocated to receive up to 12 acupuncture treatments over 3 months or to a control intervention offering usual care.Main outcome measures: Outcome measures included headache score; assessment of Short Form 36 (SF-36) health status and use of medication at baseline, 3 months and 12 months; assessment of use of resources every 3 months; and assessment of incremental cost per quality-adjusted life-year ( QALY) gained.Results: Headache score at 12 months, the primary end-point, was lower in the acupuncture group than in controls. The adjusted difference between means was 4.6. This result was robust to sensitivity analysis incorporating imputation for missing data. Patients in the acupuncture group experienced the equivalent of 22 fewer days of headache per year. SF-36 data favoured acupuncture, although differences reached significance only for physical role functioning, energy and change in health. Compared with controls, patients randomised to acupuncture used 15{\%} less medication, made 25{\%} fewer visits to GPs and took 15{\%} fewer days off sick. Total costs during the 1-year period of the study were on average higher for the acupuncture group than for controls because of the acupuncture practitioners' costs. The mean health gain from acupuncture during the year of the trial was 0.021 QALYs, leading to a base-case estimate of pound9180 per QALY gained. This result was robust to sensitivity analysis. Cost per QALY dropped substantially when the analysis incorporated likely QALY differences for the years after the trial.Conclusions: The study suggests that acupuncture leads to persisting, clinically relevant benefits for primary care patients with chronic headache, particularly migraine. It is relatively cost-effective compared with a number of other interventions provided by the NHS. Further studies could examine the duration of acupuncture effects beyond 1 year and the relative benefit to patients with migraine with compared to tension-type headache. Trials are also warranted examining the effectiveness and cost-effectiveness of acupuncture in patients with headache receiving more aggressive pharmacological management.",
keywords = "LOW-BACK-PAIN, TENSION-TYPE HEADACHE, CHRONIC NECK PAIN, CHINESE MEDICINE ACUPUNCTURISTS, CLINICAL-TRIAL, DOUBLE-BLIND, NEEDLE ACUPUNCTURE, COMPLEMENTARY MEDICINE, PROPHYLACTIC TREATMENT, POSTOPERATIVE PAIN",
author = "Alison Avenell and J. Broom and Brown, {Tamara Joanne} and Poobalan, {Amudha Sujatha} and Aucott, {Lorna Sharman} and Stearns, {S. C.} and Smith, {William Cairns Stewart} and Jung, {R. T.} and Campbell, {Marion Kay} and Grant, {Adrian Maxwell}",
year = "2004",
month = "5",
language = "English",
volume = "8",
pages = "1--182",
journal = "Health Technology Assessment",
issn = "1366-5278",
publisher = "National Co-ordinating Centre for HTA",
number = "21",

}

TY - JOUR

T1 - Systematic review of the long-term effects and economic consequences of treatments for obesity and implications for health improvement

AU - Avenell, Alison

AU - Broom, J.

AU - Brown, Tamara Joanne

AU - Poobalan, Amudha Sujatha

AU - Aucott, Lorna Sharman

AU - Stearns, S. C.

AU - Smith, William Cairns Stewart

AU - Jung, R. T.

AU - Campbell, Marion Kay

AU - Grant, Adrian Maxwell

PY - 2004/5

Y1 - 2004/5

N2 - Objectives: To determine the effects of a policy of using acupuncture, compared with a policy of avoiding acupuncture, on headache in primary care patients with chronic headache disorders. The effects of acupuncture on medication use, quality of life, resource use and days off sick in this population and the cost-effectiveness of acupuncture were also examined.Design: Randomised, controlled trial.Setting: General practices in England and Wales.Participants: The study included 401 patients with chronic headache disorder, predominantly migraine.Interventions: Patients were randomly allocated to receive up to 12 acupuncture treatments over 3 months or to a control intervention offering usual care.Main outcome measures: Outcome measures included headache score; assessment of Short Form 36 (SF-36) health status and use of medication at baseline, 3 months and 12 months; assessment of use of resources every 3 months; and assessment of incremental cost per quality-adjusted life-year ( QALY) gained.Results: Headache score at 12 months, the primary end-point, was lower in the acupuncture group than in controls. The adjusted difference between means was 4.6. This result was robust to sensitivity analysis incorporating imputation for missing data. Patients in the acupuncture group experienced the equivalent of 22 fewer days of headache per year. SF-36 data favoured acupuncture, although differences reached significance only for physical role functioning, energy and change in health. Compared with controls, patients randomised to acupuncture used 15% less medication, made 25% fewer visits to GPs and took 15% fewer days off sick. Total costs during the 1-year period of the study were on average higher for the acupuncture group than for controls because of the acupuncture practitioners' costs. The mean health gain from acupuncture during the year of the trial was 0.021 QALYs, leading to a base-case estimate of pound9180 per QALY gained. This result was robust to sensitivity analysis. Cost per QALY dropped substantially when the analysis incorporated likely QALY differences for the years after the trial.Conclusions: The study suggests that acupuncture leads to persisting, clinically relevant benefits for primary care patients with chronic headache, particularly migraine. It is relatively cost-effective compared with a number of other interventions provided by the NHS. Further studies could examine the duration of acupuncture effects beyond 1 year and the relative benefit to patients with migraine with compared to tension-type headache. Trials are also warranted examining the effectiveness and cost-effectiveness of acupuncture in patients with headache receiving more aggressive pharmacological management.

AB - Objectives: To determine the effects of a policy of using acupuncture, compared with a policy of avoiding acupuncture, on headache in primary care patients with chronic headache disorders. The effects of acupuncture on medication use, quality of life, resource use and days off sick in this population and the cost-effectiveness of acupuncture were also examined.Design: Randomised, controlled trial.Setting: General practices in England and Wales.Participants: The study included 401 patients with chronic headache disorder, predominantly migraine.Interventions: Patients were randomly allocated to receive up to 12 acupuncture treatments over 3 months or to a control intervention offering usual care.Main outcome measures: Outcome measures included headache score; assessment of Short Form 36 (SF-36) health status and use of medication at baseline, 3 months and 12 months; assessment of use of resources every 3 months; and assessment of incremental cost per quality-adjusted life-year ( QALY) gained.Results: Headache score at 12 months, the primary end-point, was lower in the acupuncture group than in controls. The adjusted difference between means was 4.6. This result was robust to sensitivity analysis incorporating imputation for missing data. Patients in the acupuncture group experienced the equivalent of 22 fewer days of headache per year. SF-36 data favoured acupuncture, although differences reached significance only for physical role functioning, energy and change in health. Compared with controls, patients randomised to acupuncture used 15% less medication, made 25% fewer visits to GPs and took 15% fewer days off sick. Total costs during the 1-year period of the study were on average higher for the acupuncture group than for controls because of the acupuncture practitioners' costs. The mean health gain from acupuncture during the year of the trial was 0.021 QALYs, leading to a base-case estimate of pound9180 per QALY gained. This result was robust to sensitivity analysis. Cost per QALY dropped substantially when the analysis incorporated likely QALY differences for the years after the trial.Conclusions: The study suggests that acupuncture leads to persisting, clinically relevant benefits for primary care patients with chronic headache, particularly migraine. It is relatively cost-effective compared with a number of other interventions provided by the NHS. Further studies could examine the duration of acupuncture effects beyond 1 year and the relative benefit to patients with migraine with compared to tension-type headache. Trials are also warranted examining the effectiveness and cost-effectiveness of acupuncture in patients with headache receiving more aggressive pharmacological management.

KW - LOW-BACK-PAIN

KW - TENSION-TYPE HEADACHE

KW - CHRONIC NECK PAIN

KW - CHINESE MEDICINE ACUPUNCTURISTS

KW - CLINICAL-TRIAL

KW - DOUBLE-BLIND

KW - NEEDLE ACUPUNCTURE

KW - COMPLEMENTARY MEDICINE

KW - PROPHYLACTIC TREATMENT

KW - POSTOPERATIVE PAIN

M3 - Article

VL - 8

SP - 1

EP - 182

JO - Health Technology Assessment

JF - Health Technology Assessment

SN - 1366-5278

IS - 21

ER -