Economic considerations of complementary and alternative medicine (CAM) use in Australia

The term ‘Complementary and Alternative Medicine’ (CAM) is used to describe “a broad set of health care practices that are not part of the dominant health care system”. Much of the CAM literature to date has been published in clinical, public health or psychology journals, owing to the multidisciplinary nature of various aspects of use. However, given high levels of expenditure and prevalence of use in many countries, including Australia, there is now a small but expanding health economics literature. This thesis contains seven self-contained chapters which have all been published or submitted to peer-reviewed journals and which contribute significantly to this area. The overarching objective of this thesis is to better understand the policy implications of CAM use in Australia from a health economics perspective. This thesis also forms the health economics component of a large, interdisciplinary, National Health and Medical Research Council (NHMRC) funded project titled ‘Complementary and Alternative Medicine, Economics, Lifestyle and Other Therapeutic approaches for chronic conditions’ (CAMelot). The project focuses on the strong link between CAM use and chronic illness, especially two of the most prevalent and resource consuming chronic conditions in Australia - type 2 diabetes and cardiovascular disease. One of the important contributions of this thesis is to characterise the use of CAM in the general population and compare and contrast this to the sub-group of people living with chronic illness. Throughout the chapters, differences emerged between different types of CAM use, for example, different explanatory factors were associated with CAM practitioner use compared with product use. Chronic illnesses, particularly mental health conditions, are found to be predictive of both CAM practitioner and product use. In contrast, healthy behaviours such as being a healthy weight, exercising and not smoking were more likely to be associated with CAM users compared with non-users, perhaps suggesting two different ‘types’ of CAM user – a more healthy, motivated CAM user and one who is likely to have one or more chronic illnesses. In terms of the consequences of CAM use by people with chronic illness, a consistent negative correlation was found between CAM use and QoL. It is plausible that this association may work in either direction. Low QoL may be seen as a driver of CAM use, perhaps suggesting that CAM is utilised to mitigate against side effects of conventional treatment or as a ‘last resort’. Alternatively, inappropriate or ineffective CAM use may lead to a decrease in QoL. If the latter is true, it supports the notion of additional consumer support by way of regulation or the provision of (trustworthy) information upon which to base an informed decision. The final two chapters of the thesis explore the potential effect of proposed changes to the labelling of CMs in Australia. Chapter Six uses new generation eye-tracking to better understand how consumers process information during in a complex decision-making environment. In particular we find evidence of decision rules, or simplifying heuristics which may be used as a coping mechanism and have implications for the design of preferences studies in healthcare more generally. In Chapter Seven, results of a discrete choice experiment are presented which suggest that additional labelling has the potential to change consumer behaviour and therefore may be a useful policy intervention. In particular, positively worded statement regarding the regulation status of products are preferred to negatively worded ones and the addition of a traffic-light system to summarise evidence of effectiveness, side-effects and interactions was generally utility enhancing for consumers. Overall, this thesis contributes significantly in an under researched area, given such high prevalence and expenditure, presenting novel and exciting research, in an area which offers many opportunities for future health economics insights. Future research may include an expansion of health technology assessment of individual CAM modalities and treatments; the likely effect of public subsidy of selected CAM modalities on the use of existing subsidised conventional services; and consumer preferences for CAM therapies for different health complaints